Health care utilization among adenosine-sensitive supraventricular tachycardia patients presenting to the emergency department

Thomas A. Dewland, Adam Oesterle, John Stein, Gregory M. Marcus

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: Although adenosine-sensitive supraventricular tachycardia (SVT) is generally curable, it remains an important cause of healthcare utilization. We sought to determine predictors of health care utilization among SVT patients presenting to the emergency department (ED). Methods: We studied consecutive patients evaluated in an urban, academic ED for adenosine-sensitive SVT. The primary study outcomes were (1) ambulance transportation to the index ED visit, (2) hospital admission from the index ED encounter, and (3) recurrent SVT-associated ED encounters. Results: Among 100 patients with adenosine-sensitive SVT, 35 were transported to the ED by ambulance. Prior electrophysiologist evaluation was associated with a significant 87% reduced odds of ambulance utilization (OR 0.13, 95% CI 0.03–0.67, p = 0.015). A total of 62 patients were subsequently admitted to the hospital. All patients with coronary artery disease, diabetes, syncope, and wide complex SVT were admitted. Similarly, individuals with an elevated troponin had a significantly greater odds of hospital admission (OR 16.8, 95% CI 1.9–148.4, p = 0.011). After the index ED visit, 60 patients were seen by an electrophysiologist, and 47 underwent catheter ablation. Individuals treated with catheter ablation had a significant 75% reduction in the risk of a recurrent ED visit for SVT (HR 0.25, 95% CI 0.10–0.62, p = 0.003). Conclusions: Readily modifiable clinical factors, including a previous visit to an electrophysiologist and treatment with catheter ablation, are associated with reduced health care utilization among patients presenting to the ED with SVT.

Original languageEnglish (US)
Pages (from-to)103-109
Number of pages7
JournalJournal of Interventional Cardiac Electrophysiology
Volume49
Issue number2
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

Fingerprint

Patient Acceptance of Health Care
Supraventricular Tachycardia
Adenosine
Hospital Emergency Service
Ambulances
Catheter Ablation
Troponin
Syncope
Risk Reduction Behavior
Coronary Artery Disease
Outcome Assessment (Health Care)
Delivery of Health Care

Keywords

  • Adenosine
  • Catheter ablation
  • Emergency department
  • Healthcare utilization
  • Supraventricular tachycardia
  • SVT

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Health care utilization among adenosine-sensitive supraventricular tachycardia patients presenting to the emergency department. / Dewland, Thomas A.; Oesterle, Adam; Stein, John; Marcus, Gregory M.

In: Journal of Interventional Cardiac Electrophysiology, Vol. 49, No. 2, 01.08.2017, p. 103-109.

Research output: Contribution to journalArticle

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abstract = "Purpose: Although adenosine-sensitive supraventricular tachycardia (SVT) is generally curable, it remains an important cause of healthcare utilization. We sought to determine predictors of health care utilization among SVT patients presenting to the emergency department (ED). Methods: We studied consecutive patients evaluated in an urban, academic ED for adenosine-sensitive SVT. The primary study outcomes were (1) ambulance transportation to the index ED visit, (2) hospital admission from the index ED encounter, and (3) recurrent SVT-associated ED encounters. Results: Among 100 patients with adenosine-sensitive SVT, 35 were transported to the ED by ambulance. Prior electrophysiologist evaluation was associated with a significant 87{\%} reduced odds of ambulance utilization (OR 0.13, 95{\%} CI 0.03–0.67, p = 0.015). A total of 62 patients were subsequently admitted to the hospital. All patients with coronary artery disease, diabetes, syncope, and wide complex SVT were admitted. Similarly, individuals with an elevated troponin had a significantly greater odds of hospital admission (OR 16.8, 95{\%} CI 1.9–148.4, p = 0.011). After the index ED visit, 60 patients were seen by an electrophysiologist, and 47 underwent catheter ablation. Individuals treated with catheter ablation had a significant 75{\%} reduction in the risk of a recurrent ED visit for SVT (HR 0.25, 95{\%} CI 0.10–0.62, p = 0.003). Conclusions: Readily modifiable clinical factors, including a previous visit to an electrophysiologist and treatment with catheter ablation, are associated with reduced health care utilization among patients presenting to the ED with SVT.",
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