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Akin-Imran A, Bajpai A, McCartan D, Heaney LG, Kee F, Redmond C, Busby J. Ethnic variation in asthma healthcare utilisation and exacerbation: systematic review and meta-analysis. ERJ Open Res 2023; 9:00591-2022. [PMID: 37143831 PMCID: PMC10152257 DOI: 10.1183/23120541.00591-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/10/2023] [Indexed: 05/06/2023] Open
Abstract
Background Patients from ethnic minority groups (EMGs) frequently report poorer asthma outcomes; however, a broad synthesis summarising ethnic disparities is yet to be undertaken. What is the magnitude of ethnic disparities in asthma healthcare utilisation, exacerbations and mortality? Methods MEDLINE, Embase and Web of Science databases were searched for studies reporting ethnic variation in asthma healthcare outcomes (primary care attendance, exacerbation, emergency department (ED) visits, hospitalisation, hospital readmission, ventilation/intubation and mortality) between White patients and those from EMGs. Estimates were displayed using forest plots and random-effects models were used to calculate pooled estimates. We conducted subgroup analyses to explore heterogeneity, including by specific ethnicity (Black, Hispanic, Asian and other). Results 65 studies, comprising 699 882 patients, were included. Most studies (92.3%) were conducted in the United States of America (USA). Patients from EMGs had evidence suggestive of lower levels of primary care attendance (OR 0.72, 95% CI 0.48-1.09), but substantially higher ED visits (OR 1.74, 95% CI 1.53-1.98), hospitalisations (OR 1.63, 95% CI 1.48-1.79) and ventilation/intubation (OR 2.67, 95% CI 1.65-4.31) when compared to White patients. In addition, we found evidence suggestive of increased hospital readmissions (OR 1.19, 95% CI 0.90-1.57) and exacerbation rates (OR 1.10, 95% CI 0.94-1.28) among EMGs. No eligible studies explored disparities in mortality. ED visits were much higher among Black and Hispanic patients, while Asian and other ethnicities had similar rates to White patients. Conclusions EMGs had higher secondary care utilisation and exacerbations. Despite the global importance of this issue, the majority of studies were performed in the USA. Further research into the causes of these disparities, including whether these vary by specific ethnicity, is required to aid the design of effective interventions.
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Affiliation(s)
- AbdulQadr Akin-Imran
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Achint Bajpai
- University of Central Lancashire, University of Central Lancashire Faculty of Clinical and Biomedical Sciences, Preston, UK
| | - Dáire McCartan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Liam G. Heaney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Frank Kee
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Charlene Redmond
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
- Corresponding author: John Busby ()
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Hirayama A, Goto T, Faridi MK, Camargo CA, Hasegawa K. Association of obstructive sleep apnea with all-cause readmissions after hospitalization for asthma exacerbation in adults aged 18-54 years: a population-based study, 2010-2013. J Asthma 2021; 58:1176-1185. [PMID: 32521180 PMCID: PMC7762726 DOI: 10.1080/02770903.2020.1781887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate associations between obstructive sleep apnea (OSA) and readmission risk after hospitalization for asthma exacerbation. METHODS We conducted a retrospective, population-based cohort study using State Inpatient Databases from seven U.S. states (Arkansas, California, Florida, Iowa, Nebraska, New York, and Utah) from 2010 to 2013. We identified all adults (aged 18-54 years) hospitalized for asthma exacerbation. The outcome measure was all-cause readmissions within one year after hospitalization for asthma exacerbation. To determine associations between OSA and readmission risk, we constructed negative binomial regression models estimating the incidence rate ratio (IRR) for readmissions and Cox proportional hazards models estimating hazard rate (HR) for the time-to-first readmission. RESULTS Among 65,731 patients hospitalized for asthma exacerbation, 6,549 (10.0%) had OSA. Overall, OSA was associated with significantly higher incident rate of all cause readmission (1.36 vs. 0.85 readmissions per person-year; unadjusted IRR 1.60; 95%CI 1.54-1.66). Additionally, OSA was associated with higher incident rates of readmissions for five major diseases-asthma (IRR 1.21; 95%CI 1.15-1.27), COPD (IRR 2.03; 95%CI 1.88-2.19), respiratory failure (IRR 3.04; 95%CI 2.76-3.34), pneumonia (IRR 1.67; 95%CI 1.49-1.88), and congestive heart failure (IRR 3.78; 95%CI 3.36-4.24), compared to non-OSA. The Cox model demonstrated that patients with OSA had significantly higher rates for all-cause readmission compared to those without OSA (HR 1.56; 95% CI 1.50-1.62). These associations remained significant after adjustment for confounders. CONCLUSIONS The observed association of OSA with a higher risk of readmissions after hospitalization for asthma exacerbation underscores the importance of identifying coexistent OSA in this population and optimizing both OSA and asthma management.
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Affiliation(s)
- Atsushi Hirayama
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Tadahiro Goto
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
- Harvard T.H. Chan School of Public Health, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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Tejwani V, Chang HY, Tran AP, Naber JA, Gutzwiller FS, Winders TA, Khurana S, Sumino K, Mosnaim G, Moloney RM. A multistakeholder Delphi consensus core outcome set for clinical trials in moderate-to-severe asthma (coreASTHMA). Ann Allergy Asthma Immunol 2021; 127:116-122.e7. [PMID: 33781936 DOI: 10.1016/j.anai.2021.03.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/09/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Treatments for long-term control of asthma have improved and include a promising but expensive class of biologic therapies. However, the clinical trials evaluating these and other novel treatments have used a variety of different outcomes to evaluate efficacy. The evolution of asthma care calls for a re-examination of outcomes that are most important to patients and other stakeholders. OBJECTIVE To develop a core set of outcomes to be measured in phase 3 and phase 4 clinical drug trials in patients with moderate-to-severe asthma. METHODS We used a robust and in-depth multistakeholder consensus process bringing together patients, clinicians, regulators, payers, health technology assessors, researchers, and product developers to reach consensus on outcomes. We used a modified Delphi method to reach consensus, an approach adapted from the Core Outcome Measures in Effectiveness Trials Initiative aligned with contemporary methodological standards for core outcome set development. RESULTS The following outcomes were included in the final core set: severe asthma exacerbation, change in asthma control, asthma-specific or severe asthma-specific quality of life, asthma-specific hospital stay (ie, >24-hour stays at any level of care) or admission, and asthma-specific emergency department visit. CONCLUSION These 5 outcomes represent a minimum set of core outcomes for use in phase 3 and phase 4 clinical drug trials in moderate-to-severe asthma. Consistent collection of these outcomes as minimum, independent of whether additional heterogeneous primary or secondary outcomes are included, will allow for meaningful comparisons of the effect of asthma therapies across clinical trials.
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Affiliation(s)
- Vickram Tejwani
- Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland.
| | | | - Annie P Tran
- Center for Medical Technology Policy, Baltimore, Maryland
| | | | | | | | - Sandhya Khurana
- Pulmonary and Critical Care Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Kaharu Sumino
- Pulmonary and Critical Care Medicine, Washington University, St. Louis, Missouri
| | - Giselle Mosnaim
- Pulmonary, Allergy and Critical Care, NorthShore University HealthSystem, Evanston, Illinois
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Management of Asthma Exacerbations in the Emergency Department. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:2599-2610. [PMID: 33387672 DOI: 10.1016/j.jaip.2020.12.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 02/06/2023]
Abstract
Asthma exacerbations occur across a wide spectrum of chronic severity; they contribute to millions of emergency department (ED) visits in both children and adults every year. Management of asthma exacerbations is an important part of the continuum of asthma care. The best strategy for ED management of an asthma exacerbation is early recognition and intervention, continuous monitoring, appropriate disposition, and, once improved, multifaceted transitional care that optimizes subacute and chronic asthma management after ED discharge. This article concisely reviews ED evaluation, treatment, disposition, and postdischarge care for patients with asthma exacerbations, based on high-quality evidence (eg, systematic reviews from the Cochrane Collaboration) and current international guidelines (eg, the National Asthma Education and Prevention Program Expert Panel Report 3, Global Initiative for Asthma, and Australian guidelines). Special populations (young children, pregnant women, and the elderly) also are addressed. Despite advances in asthma science, there remain many important evidence gaps in managing ED patients with asthma exacerbation. This article summarizes several of these controversial areas and challenges that merit further investigation.
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Peng J, Chen C, Zhou M, Xie X, Zhou Y, Luo CH. A Machine-learning Approach to Forecast Aggravation Risk in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Clinical Indicators. Sci Rep 2020; 10:3118. [PMID: 32080330 PMCID: PMC7033165 DOI: 10.1038/s41598-020-60042-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 02/04/2020] [Indexed: 11/10/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) repeat acute exacerbations (AE). Global Initiative for Chronic Obstructive Lung Disease (GOLD) is only available for patients in stable phase. Currently, there is a lack of assessment and prediction methods for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients during hospitalization. To enhance the monitoring and treatment of AECOPD patients, we develop a novel C5.0 decision tree classifier to predict the prognosis of AECOPD hospitalized patients with objective clinical indicators. The medical records of 410 hospitalized AECOPD patients are collected and 28 features including vital signs, medical history, comorbidities and various inflammatory indicators are selected. The overall accuracy of the proposed C5.0 decision tree classifier is 80.3% (65 out of 81 participants) with 95% Confidence Interval (CI):(0.6991, 0.8827) and Kappa 0.6054. In addition, the performance of the model constructed by C5.0 exceeds the C4.5, classification and regression tree (CART) model and the iterative dichotomiser 3 (ID3) model. The C5.0 decision tree classifier helps respiratory physicians to assess the severity of the patient early, thereby guiding the treatment strategy and improving the prognosis of patients.
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Affiliation(s)
- Junfeng Peng
- Sun Yat-sen University, School of Data and Computer Science, Guangzhou, 510006, China
| | - Chuan Chen
- Sun Yat-sen University, School of Data and Computer Science, Guangzhou, 510006, China
| | - Mi Zhou
- Sun Yat-sen University, The Third Affiliated Hospital, Guangzhou, 510640, China
| | - Xiaohua Xie
- Sun Yat-sen University, School of Data and Computer Science, Guangzhou, 510006, China
| | - Yuqi Zhou
- Sun Yat-sen University, The Third Affiliated Hospital, Guangzhou, 510640, China.
| | - Ching-Hsing Luo
- Sun Yat-sen University, School of Data and Computer Science, Guangzhou, 510006, China.
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A Predictive Model for Identification of Children at Risk of Subsequent High-Frequency Utilization of the Emergency Department for Asthma. Pediatr Emerg Care 2020; 36:e85-e89. [PMID: 31181024 PMCID: PMC6895410 DOI: 10.1097/pec.0000000000001866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Asthma is the most common chronic condition among children with high-frequency emergency department (ED) utilization. Previous research has shown in outpatients seen for asthma that acute care visits predict subsequent health care utilization. Among ED patients, however, the optimal method of predicting subsequent ED utilization remains to be described. The goal of this study was to create a predictive model to identify children in the ED who are at risk of subsequent high-frequency utilization of the ED for asthma. METHODS We used 3 years of data, 2013-2015, drawn from the electronic health records at a tertiary care, urban, children's hospital that is a high-volume center for asthma care. Data were split into a derivation (50%) and validation/test (50%) set, and 3 models were created for testing: (1) all index patients; (2) removing patients with complex chronic conditions; and (3) subset of patients with in-network care on whom more clinical data were available. Each multivariable model was then tested in the validation set, and its performance evaluated by predicting error rate, calculation of a receiver operating characteristic (ROC) curve, and identification of the optimal cutpoint to maximize sensitivity and specificity. RESULTS There were 5535 patients with index ED visits, of whom 2767 were in the derivation set and 2768 in the validation set. Of the 5535 patients, 125 patients (2.3%) had 4 or more visits for asthma in the outcome year. Significant predictors in models 1 and 2 were age and number of prior ED visits for asthma. For model 3 (additional clinical information available), the predictors were number of prior ED visits for asthma, number of primary care visits, and not having a controller medication. Areas under the ROC curve were 0.77 for model 1, 0.80 for model 2, and 0.77 for model 3. CONCLUSIONS Administrative data available at the time of ED triage can predict subsequent high utilization of the ED, with areas under the ROC curve of 0.77 to 0.80. The addition of clinical variables did not improve the model performance. These models provide useful tools for researchers interested in examining intervention efficacy by predicted risk group.
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Shimada YJ, Goto T, Takayama H, Brown DFM, Homma S, Maurer MS, Reilly MP, Hasegawa K. Comparison of Effectiveness of Alcohol Septal Ablation Versus Ventricular Septal Myectomy on Acute Care Use for Cardiovascular Disease in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2019; 124:1272-1278. [PMID: 31447010 PMCID: PMC11015905 DOI: 10.1016/j.amjcard.2019.07.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/12/2019] [Accepted: 07/15/2019] [Indexed: 11/30/2022]
Abstract
Alcohol septal ablation (ASA) and ventricular septal myectomy (VSM) are 2 options of ventricular septal reduction therapy (VSRT) for obstructive hypertrophic cardiomyopathy (HC). We hypothesized that patients with HC who underwent ASA have a higher risk of acute care use (i.e., emergency department [ED] visit or unplanned hospitalization) for cardiovascular disease (CVD) than VSM. We performed a comparative effectiveness study of ASA versus VSM (reference group) among patients with HC who underwent VSRT, using population-based ED and inpatient databases in 3 states, 2005 to 2014. The outcome was acute care use for CVD during a 2-year post-VSRT period. We constructed univariable and multivariable logistic regression models to compare the risk during sequential 6-month periods. We also performed sensitivity analysis with propensity score-matching at 1:1 ratio. We identified 850 patients with HC who underwent VSRT, including 393 with ASA and 457 with VSM. During 13 to 18 months after VSRT, there was a nonsignificantly higher risk with ASA than VSM (adjusted odds ratio [OR] 1.73; 95% confidence interval [CI] 0.83 to 3.60; p = 0.14). Patients who had ASA had a significantly higher risk in the 19 to 24 months post-VSRT period (adjusted OR 2.12; 95% CI 1.06 to 4.23; p = 0.03). Similarly, the propensity score-matched analysis demonstrated a higher risk with ASA than VSM during 13 to 18 months (OR 2.97; 95% CI 1.04 to 8.46; p = 0.04) and 19 to 24 months (OR 7.06; 95% CI 2.04 to 24.36; p = 0.002) after VSRT. In conclusion, among 850 patients with HC who underwent VSRT, the risk of acute care use for CVD was higher after ASA than VSM during the second post-VSRT year.
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Affiliation(s)
- Yuichi J Shimada
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York; Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Tadahiro Goto
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hiroo Takayama
- Department of Surgery, Columbia University Medical Center, New York, New York
| | - David F M Brown
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shunichi Homma
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Mathew S Maurer
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Muredach P Reilly
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Lahiri S, Gil W, Daria S, Joshua G, Parul J, Redmond B, Elizabeth W. Genetic abnormalities/syndromes significantly impact perioperative outcomes of conotruncal heart defects. Ann Pediatr Cardiol 2019; 13:38-45. [PMID: 32030034 PMCID: PMC6979035 DOI: 10.4103/apc.apc_51_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/05/2019] [Accepted: 07/23/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives: The main objective of the study is to characterize the effects of genetic abnormalities/syndromes (GA/S) on perioperative outcomes of cardiac surgeries involving repair of conotruncal heart defects (CTHD). Design: The study involves a single-center retrospective analysis of patients who underwent complete repair of CTHDs (tetralogy of Fallot [TOF], truncus arteriosus, interrupted aortic arch, and ventricular septal defect with coarctation) between January 2000 and December 2015. The primary outcome was the post operative length of stay (PLOS). The secondary outcomes were mortality, cardiac complications, hematologic complications, infections, and number of medications-at-discharge. Setting: Cardiac intensive care unit in a tertiary pediatric hospital in South Florida that performs around 300 open-heart surgeries a year. Subjects: A total of 177 patients with CTHDs who underwent cardiac surgeries in the stated time period were included in the final study cohort. Measurements and Main Results: Majority of patients had TOF (72.5%) and 46 (26%) had GA/S. The most common GA/S was 22q11 deletion (37%). PLOS was significantly increased in patients with GA/S (P < 0.05). Patients with GA/S were 4.5 times more likely to have a postoperative cardiac complication, 4.2 times more likely to have a postoperative infection, and received 1.6 times more medications at discharge than those without GA/S. However, GA/S was not associated with increased perioperative mortality. Black patients were three times more likely to have a longer PLOS than White patients. Conclusions: Perioperative outcomes in patients with GA/S suggested an increased residual cardiovascular disease and increased resource usage. Notably, this is the first study demonstrating the effect of race and ethnicity on PLOS in CTHD patients.
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Affiliation(s)
- Subhrajit Lahiri
- Pediatric Cardiology, Texas Children's Hospital, Houston, Texas, USA
| | - Wernovsky Gil
- Pediatric Cardiology, Children's National Health System, Washington, DC, USA
| | - Salyakina Daria
- Heart Center, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Gruber Joshua
- Heart Center, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Jayakar Parul
- Heart Center, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Burke Redmond
- Heart Center, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Welch Elizabeth
- Heart Center, Nicklaus Children's Hospital, Miami, Florida, USA
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Raita Y, Camargo CA, Faridi MK, Brown DFM, Shimada YJ, Hasegawa K. Risk of Acute Myocardial Infarction and Ischemic Stroke in Patients with Asthma Exacerbation: A Population-Based, Self-Controlled Case Series Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:188-194.e8. [PMID: 31323338 DOI: 10.1016/j.jaip.2019.06.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/20/2019] [Accepted: 06/28/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with asthma have a high incidence of acute myocardial infarction and ischemic stroke. OBJECTIVE To investigate the acute effect of asthma exacerbation on these cardiovascular events. METHODS Using population-based inpatient data of 3 geographically diverse US states (Florida, Nebraska, and New York) during the period 2011 to 2014, we conducted a self-controlled case series study of adults (aged ≥40 years) hospitalized with asthma exacerbation. The primary outcome was a composite of acute myocardial infarction and ischemic stroke. We used conditional Poisson regression to compare each patient's incidence rate of the outcome during 3 sequential risk periods (1-7, 8-14, and 15-28 days after asthma exacerbation) with that of the reference period (ie, summed period before and after the 3 risk periods). RESULTS We identified 4607 adults hospitalized for asthma exacerbation who had a first episode of acute myocardial infarction or ischemic stroke. During the reference period, the incidence rate of acute myocardial infarction or ischemic stroke was 25.0/100 person-years. Compared with the reference period, the incidence rate significantly increased during the first risk period (129.1/100 person-years), with a corresponding adjusted incidence rate ratio of 5.04 (95% CI, 4.29-5.88; P < .001). In the 2 subsequent risk periods, the incidence rate declined but remained high-50.1/100 person-years (adjusted incidence rate ratio, 1.96; 95% CI, 1.51-2.48; P < .001) and 38.0/100 person-years (adjusted incidence rate ratio, 1.48; 95% CI, 1.20-1.81; P < .001), respectively. The findings were similar when the 2 outcomes were examined separately. CONCLUSIONS In this population-based study of adults with asthma, the risk of acute myocardial infarction and ischemic stroke increased significantly after asthma exacerbation.
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Affiliation(s)
- Yoshihiko Raita
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Mohammad Kamal Faridi
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - David F M Brown
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Yuichi J Shimada
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
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Morikawa M, Hagiwara Y, Gibo K, Goto T, Watase H, Hasegawa K. Methylxanthine use for acute asthma in the emergency department in Japan: a multicenter observational study. Acute Med Surg 2019; 6:279-286. [PMID: 31304030 PMCID: PMC6603322 DOI: 10.1002/ams2.408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/27/2019] [Indexed: 11/09/2022] Open
Abstract
AIM Methylxanthines are no longer recommended for emergency department (ED) patients with acute asthma according to international guidelines. We aimed to describe the current methylxanthine use for acute asthma and to determine factors related to its use in the ED. METHODS We undertook a multicenter retrospective study in 23 EDs across Japan. From each participating hospital, we randomly identified 60 ED patients aged 18-54 years with acute asthma from 2009 through 2011. We examined the associations of ED and patient characteristics with methylxanthine use by constructing a multivariable logistic regression model adjusting for a predefined set of ED- and patient-level factors. RESULTS Among 1,380 patients, methylxanthines were used for 79 patients (5.7%, 95% confidence interval [CI], 4.6-7.0%). The proportion of methylxanthine treatment varied substantially among EDs, ranging from 0% to 26.1%. In the multivariable analysis, the number of annual ED patients with acute asthma (odds ratio [OR] per 100 increase in annual asthma patients, 0.12; 95% CI, 0.04-0.34; P < 0.001) and having a protocol for asthma treatment (OR 2.91; 95% CI, 1.06-8.00; P = 0.04) at the ED level, and systemic corticosteroid use (OR 6.39; 95% CI, 3.34-12.22; P < 0.001) at the patient level were associated with likelihood of methylxanthine use. CONCLUSIONS In this multicenter study, approximately 6% of ED patients with acute asthma were treated with methylxanthines, with a wide variation across EDs. The number of annual ED patients with acute asthma was significantly associated with a lower likelihood of methylxanthine use, whereas having an ED asthma treatment protocol and systemic corticosteroid use in the ED were associated with a higher likelihood of methylxanthine treatment.
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Affiliation(s)
- Miki Morikawa
- Department of Emergency and Critical Care MedicineJuntendo University Urayasu HospitalChibaJapan
| | - Yusuke Hagiwara
- Department of Pediatric Emergency MedicineTokyo Metropolitan Children's Medical CenterTokyoJapan
| | - Koichiro Gibo
- Department of Emergency MedicineOkinawa Prefectural Chubu HospitalOkinawaJapan
| | - Tadahiro Goto
- Graduate School of Medical SciencesUniversity of FukuiFukuiJapan
| | - Hiroko Watase
- Department of SurgeryUniversity of WashingtonSeattleWashington
| | - Kohei Hasegawa
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusetts
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"Characteristics of patients admitted to emergency department for asthma attack: a real-LIFE study". BMC Pulm Med 2019; 19:107. [PMID: 31208388 PMCID: PMC6580601 DOI: 10.1186/s12890-019-0869-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/06/2019] [Indexed: 11/29/2022] Open
Abstract
Background Asthma is a chronic disease affecting 30 million people in Europe under 45y. Poor control of Asthma is the main cause of emergency-department (ED) access, becoming the strongest determinant of the economic burden of asthma management. Objective To examine the characteristics of adult patients admitted to ED for acute asthma attack, focusing on previous diagnosis of asthma (DA) and current therapy. Methods During a one-year period, a structured questionnaire, assessing asthma diagnosis and management, was administered to all patients admitted for asthma attack, to the ED of a South-Italy town. Only patients with subsequently confirmed asthma were enrolled. The data on oxygen saturation (Sat.O2), heart and respiratory-rate, severity code ED-admission, hospitalization or discharge, had been obtained. Results Two hundred one patients (mean 50.3ys), were enrolled. One hundred eighteen had a DA, made 17.5 ± 5.88 years before, and 35.6% had a specialist-examination in the last year. 53.3% of DA-patients used a self-medication before ED access with short-acting-beta-2-agonist and oral-corticosteroids, although none had a written-asthma-action-plan (WAAP). Almost all DA-patients were on regular therapy: inhaled-corticosteroids (ICS) in 61%, associated with LABA in 85%. 16.7% of DA-patients had previous DA-access. The overall hospitalization-rate was 39%, higher in DA compared to unknown asthmatic patients (UA)(p = 0.017). Significant risk factors for hospitalization were Sat-O2 ≤ 94% breathing ambient air (OR9.91, p < 0.001), inability-to-complete a sentence (OR9.42,p < 0.001) and the age (OR1.02,p = 0.049). Conclusion Despite the asthma guidelines-recommendation, up to 40% of patients received the asthma diagnosis in ED, only 61% of DA-patients were taking ICS. It is disappointing that DA-patients did not have a WAAP, which could explain the poor patient-self-medication at ED admission. Electronic supplementary material The online version of this article (10.1186/s12890-019-0869-8) contains supplementary material, which is available to authorized users.
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Chiu Y, Racine-Hemmings F, Dufour I, Vanasse A, Chouinard MC, Bisson M, Hudon C. Statistical tools used for analyses of frequent users of emergency department: a scoping review. BMJ Open 2019; 9:e027750. [PMID: 31129592 PMCID: PMC6537981 DOI: 10.1136/bmjopen-2018-027750] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Frequent users represent a small proportion of emergency department users, but they account for a disproportionately large number of visits. Their use of emergency departments is often considered suboptimal. It would be more efficient to identify and treat those patients earlier in their health problem trajectory. It is therefore essential to describe their characteristics and to predict their emergency department use. In order to do so, adequate statistical tools are needed. The objective of this study was to determine the statistical tools used in identifying variables associated with frequent use or predicting the risk of becoming a frequent user. METHODS We performed a scoping review following an established 5-stage methodological framework. We searched PubMed, Scopus and CINAHL databases in February 2019 using search strategies defined with the help of an information specialist. Out of 4534 potential abstracts, we selected 114 articles based on defined criteria and presented in a content analysis. RESULTS We identified four classes of statistical tools. Regression models were found to be the most common practice, followed by hypothesis testing. The logistic regression was found to be the most used statistical tool, followed by χ2 test and t-test of associations between variables. Other tools were marginally used. CONCLUSIONS This scoping review lists common statistical tools used for analysing frequent users in emergency departments. It highlights the fact that some are well established while others are much less so. More research is needed to apply appropriate techniques to health data or to diversify statistical point of views.
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Affiliation(s)
- Yohann Chiu
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - François Racine-Hemmings
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Isabelle Dufour
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Alain Vanasse
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Shimada YJ, Gibo K, Tsugawa Y, Goto T, Yu EW, Iso H, Brown DF, Hasegawa K. Bariatric surgery is associated with lower risk of acute care use for cardiovascular disease in obese adults. Cardiovasc Res 2019; 115:800-806. [PMID: 30357327 PMCID: PMC11008727 DOI: 10.1093/cvr/cvy266] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/22/2018] [Accepted: 10/23/2018] [Indexed: 04/13/2024] Open
Abstract
AIMS Studies have suggested relationships between obesity and cardiovascular disease (CVD) morbidity. However, little is known about whether substantial weight reduction affects the risk of CVD-related acute care use in obese patients with CVD. The objective of this study was to determine whether bariatric surgery is associated with decreased risk of CVD-related acute care use. METHODS AND RESULTS We performed a self-controlled case series study of obese adults with CVD who underwent bariatric surgery, using population-based emergency department (ED), and inpatient samples in California, Florida, and Nebraska from 2005 to 2011. The primary outcome was ED visit or unplanned hospitalization for CVD. We used conditional logistic regression to compare the risk during sequential 12-month periods, using pre-surgery months 13-24 as the reference period. We identified 11 106 obese adults with CVD who underwent bariatric surgery. During the reference period, 20.6% [95% confidence interval (CI), 19.8-21.3%] of patients had an ED visit or unplanned hospitalization for CVD. The risk did not significantly change in the subsequent 12-month pre-surgery period [adjusted odds ratio (aOR) 0.98; 95% CI, 0.93-1.04; P = 0.42]. By contrast, in the first 12-month period after bariatric surgery, the risk significantly decreased (aOR 0.91; 95% CI, 0.86-0.96; P = 0.002). The risk remained reduced in the subsequent 13-24 months post-bariatric surgery (aOR 0.84; 95% CI, 0.79-0.89; P < 0.001). There was no reduction in the risk in separate obese populations that underwent non-bariatric surgery (i.e. cholecystectomy, hysterectomy). By CVD category, the risk of acute care use for coronary artery disease (CAD), heart failure (HF), and hypertension decreased after bariatric surgery, whereas that of dysrhythmia and venous thromboembolism transiently increased (Bonferroni corrected P < 0.05 for all comparisons). CONCLUSION Bariatric surgery is associated with a lower risk of overall CVD-related ED visit or unplanned hospitalization. The decline was mainly driven by reduced risk of acute care use for CAD, HF, and hypertension after bariatric surgery.
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Affiliation(s)
- Yuichi J. Shimada
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, 622 West 168th Street, PH3-342, New York, NY 10032, USA
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA
| | - Koichiro Gibo
- Department of Emergency Medicine, Okinawa Prefectural Chubu Hospital, 281 Miyazato, Uruma, Okinawa, Japan
| | - Yusuke Tsugawa
- Division of General Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, 911 Broxton Avenue, Los Angeles, CA, USA
| | - Tadahiro Goto
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 125 Nashua Street, Suite 920, Boston, MA, USA
| | - Elaine W. Yu
- Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Their 1051, Boston, MA, USA; and
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - David F.M. Brown
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 125 Nashua Street, Suite 920, Boston, MA, USA
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 125 Nashua Street, Suite 920, Boston, MA, USA
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Zook HG, Payne NR, Puumala SE, Burgess K, Kharbanda AB. Racial/Ethnic Variation in Emergency Department Care for Children With Asthma. Pediatr Emerg Care 2019; 35:209-215. [PMID: 28926508 PMCID: PMC5857394 DOI: 10.1097/pec.0000000000001282] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess the variation between racial/ethnic groups in emergency department (ED) treatment of asthma for pediatric patients. METHODS This study was a cross-sectional analysis of pediatric (2-18 years) asthma visits among 6 EDs in the Upper Midwest between June 2011 and May 2012. We used mixed-effects logistic regression to assess the odds of receiving steroids, radiology tests, and returning to the ED within 30 days. We conducted a subanalysis of asthma visits where patients received at least 1 albuterol treatment in the ED. RESULTS The sample included 2909 asthma visits by 1755 patients who were discharged home from the ED. After adjusting for demographics, insurance type, and triage score, African American (adjusted odds ratio [aOR], 1.78; 95% confidence interval [CI], 1.40-2.26) and Hispanic (aOR, 1.64; 95% CI, 1.22-2.22) patients had higher odds of receiving steroids compared with whites. African Americans (aOR, 0.58; 95% CI, 0.46-0.74) also had lower odds of radiological testing compared with whites. Asians had the lowest odds of 30-day ED revisits (aOR, 0.26; 95% CI, 0.08-0.84), with no other significant differences detected between racial/ethnic groups. Subgroup analyses of asthma patients who received albuterol revealed similar results, with American Indians showing lower odds of radiological testing as well (aOR, 0.47; 95% CI, 0.22-1.01). CONCLUSIONS In this study, children from racial/ethnic minority groups had higher odds of steroid administration and lower odds of radiological testing compared with white children. The underlying reasons for these differences are likely multifactorial, including varying levels of disease severity, health literacy, and access to care.
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Affiliation(s)
- Heather G. Zook
- Department of Research and Sponsored Programs, Children’s Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN 55404
- Department of Evaluation, Professional Data Analysts, Inc., 219 Main Street SE, Suite 302, Minneapolis, MN 55414
| | - Nathaniel R. Payne
- Department of Research and Sponsored Programs, Children’s Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN 55404
- Department of Quality and Safety, Children’s Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN 55404
| | - Susan E. Puumala
- Center for Health Outcomes and Prevention Research, Sanford Research, 2301 E 60th Street North, Sioux Falls, SD 57104
- Department of Pediatrics, Sanford School of Medicine at the University of South Dakota, 1400 W 22nd Street, Sioux Falls, SD 57105
| | - Katherine Burgess
- Center for Health Outcomes and Prevention Research, Sanford Research, 2301 E 60th Street North, Sioux Falls, SD 57104
- Department of Epidemiology, Colorado School of Public Health at the University of Colorado at Denver, 13001 East 17 Place, Aurora, CO 80045
| | - Anupam B. Kharbanda
- Department of Emergency Medicine, Children’s Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN 55404
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Machine learning approaches for predicting disposition of asthma and COPD exacerbations in the ED. Am J Emerg Med 2018; 36:1650-1654. [PMID: 29970272 DOI: 10.1016/j.ajem.2018.06.062] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 06/25/2018] [Accepted: 06/26/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The prediction of emergency department (ED) disposition at triage remains challenging. Machine learning approaches may enhance prediction. We compared the performance of several machine learning approaches for predicting two clinical outcomes (critical care and hospitalization) among ED patients with asthma or COPD exacerbation. METHODS Using the 2007-2015 National Hospital and Ambulatory Medical Care Survey (NHAMCS) ED data, we identified adults with asthma or COPD exacerbation. In the training set (70% random sample), using routinely-available triage data as predictors (e.g., demographics, arrival mode, vital signs, chief complaint, comorbidities), we derived four machine learning-based models: Lasso regression, random forest, boosting, and deep neural network. In the test set (the remaining 30% of sample), we compared their prediction ability against traditional logistic regression with Emergency Severity Index (ESI, reference model). RESULTS Of 3206 eligible ED visits, corresponding to weighted estimates of 13.9 million visits, 4% had critical care outcome and 26% had hospitalization outcome. For the critical care prediction, the best performing approach- boosting - achieved the highest discriminative ability (C-statistics 0.80 vs. 0.68), reclassification improvement (net reclassification improvement [NRI] 53%, P = 0.002), and sensitivity (0.79 vs. 0.53) over the reference model. For the hospitalization prediction, random forest provided the highest discriminative ability (C-statistics 0.83 vs. 0.64) reclassification improvement (NRI 92%, P < 0.001), and sensitivity (0.75 vs. 0.33). Results were generally consistent across the asthma and COPD subgroups. CONCLUSIONS Based on nationally-representative ED data, machine learning approaches improved the ability to predict disposition of patients with asthma or COPD exacerbation.
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To T, Zhu J, Ryckman K, Gershon A. Risk Factors for Return to the Emergency Department for Asthma: A Population-Based Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1907-1913.e4. [PMID: 29715564 DOI: 10.1016/j.jaip.2018.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 04/02/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND A substantial proportion of patients with asthma return after being discharged from the emergency department (ED). Given the high economic burden of acute care claims, and the impact on productivity and quality of life, a better understanding of risk factors for ED return is of interest. OBJECTIVE To quantify the rate and determine factors associated with return to the ED for asthma within 1 year of an initial ED visit for asthma. METHODS Individuals aged 5 to 99 years living in Ontario, Canada, with an ED visit for asthma in the period 2008 to 2014 were included. Descriptive statistics were used to compare those with an ED return with those without an ED return. An adjusted modified Poisson regression model was used to estimate the relative risk of ED return for asthma within 1 year after the initial discharge. RESULTS In total, 58,366 individuals met the inclusion criteria. At 1-year follow-up, 12.1% returned to the ED at least once. Younger age, being materially deprived, and having chronic obstructive pulmonary disease were significantly associated with increased risk of ED return within 1 year after the initial visit. CONCLUSIONS Nearly 1 in 8 individuals with a first ED visit for asthma returned to the ED within a year of the initial ED discharge. Targeting those at risk for ED return may help improve health care costs, productivity, and quality of life.
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Affiliation(s)
- Teresa To
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Jingqin Zhu
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Kandace Ryckman
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrea Gershon
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Hirayama A, Goto T, Shimada YJ, Faridi MK, Camargo CA, Hasegawa K. Association of Obesity With Severity of Heart Failure Exacerbation: A Population-Based Study. J Am Heart Assoc 2018; 7:JAHA.117.008243. [PMID: 29545263 PMCID: PMC5907573 DOI: 10.1161/jaha.117.008243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Obesity and heart failure (HF) are important public health problems in the United States. Although studies have reported the association between obesity and higher chronic morbidity of HF, little is known about the relations of obesity with severity of HF exacerbation and in‐hospital mortality; therefore, we aimed to investigate the associations of obesity with severity of HF exacerbation and in‐hospital mortality. Methods and Results This retrospective cohort study of adults hospitalized for HF exacerbation used population‐based data sets (the State Inpatient Databases) of 7 US states from 2012 to 2013. The outcomes were acute severity measures—use of positive pressure ventilation and hospital length of stay—and in‐hospital mortality. We determined the associations between obesity and these outcomes, including adjustment for sociodemographic factors and comorbidities. We identified 219 465 patients hospitalized for HF exacerbation. Of those, 37 539 (17.1%) were obese. Obese patients had a significantly higher risk of positive pressure ventilation use compared with nonobese patients (13.6% versus 8.8%), with a corresponding adjusted odds ratio of 1.61 (95% confidence interval, 1.55–1.68; P<0.001). Likewise, obese patients were more likely to have hospital length of stay of ≥4 days compared with nonobese patients (62.5% versus 56.7%), with an adjusted odds ratio of 1.40 (95% confidence interval, 1.37–1.44; P<0.001). In contrast, obese patients had significantly lower in‐hospital mortality compared with nonobese patients (1.7% versus 3.3%), with an adjusted odds ratio of 0.87 (95% confidence interval, 0.80–0.95; P=0.002). Conclusions Based on large population‐based data sets of patients with HF exacerbation, obesity was associated with higher acute severity measures but lower in‐hospital mortality.
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Affiliation(s)
- Atsushi Hirayama
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Tadahiro Goto
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Yuichi J Shimada
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY
| | | | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.,Harvard T.H. Chan School of Public Health, Boston, MA.,Harvard Medical School, Boston, MA
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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Mazalovic K, Jacoud F, Dima AL, Van Ganse E, Nolin M, C D, Zaba C. Asthma exacerbations and socio-economic status in French adults with persistent asthma: A prospective cohort study. J Asthma 2017; 55:1043-1051. [PMID: 29023163 DOI: 10.1080/02770903.2017.1391280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Adults disadvantaged by poor socio-economic status (SES) are more severely affected by asthma compared to those with better SES. We aimed to determine whether the frequency of asthma exacerbations (AEx), as well as aspects related to AEx management, differed based on SES in patients treated with daily treatments. METHODS This study, part of the prospective observational cohort ASTRO-LAB, included French adult patients with persistent asthma. Patients were considered as low SES if they benefited from publicly funded special health insurance and/or were perceived as low SES by their general practitioner. AEx was defined as at least one of the following: asthma-related oral corticosteroid course, medical contact, hospitalization, and death. We examined associations between SES and AEx frequency, perceived triggering factors and type of medical contact after AEx. RESULTS In our sample of 255 patients, 11.40% were considered as low SES. Patients with low SES did not report significantly more AEx than medium/high SES patients during one-year follow-up (0.79 versus 0.55, p = 0.38). The type of medical contact during AEx differed significantly between the two groups (p = 0.03): patients with medium/high SES consulted their general practitioner more frequently (OR = 2.23, 95% CI = 0.91-5.50, p = 0.08) and were less likely to visit an emergency department or be hospitalized (OR = 0.27, 95% CI = 0.09-0.84, p = 0.02). CONCLUSIONS AEx frequency did not differ significantly between low and medium/high SES patients, but differences were found in the management of AEx. Studies are needed to better understand the relation between precariousness and management of asthma.
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Affiliation(s)
- Katia Mazalovic
- a Department of General Medicine , UFR Sciences de Santé, University of Burgundy , Dijon, France
| | - Flore Jacoud
- b Lyon Pharmaco-Epidemiology Unit-HESPER EA 7425-Claude Bernard Lyon 1 University , Lyon , France
| | - Alexandra L Dima
- b Lyon Pharmaco-Epidemiology Unit-HESPER EA 7425-Claude Bernard Lyon 1 University , Lyon , France
| | - Eric Van Ganse
- b Lyon Pharmaco-Epidemiology Unit-HESPER EA 7425-Claude Bernard Lyon 1 University , Lyon , France
| | - Maeva Nolin
- b Lyon Pharmaco-Epidemiology Unit-HESPER EA 7425-Claude Bernard Lyon 1 University , Lyon , France
| | - Didier C
- a Department of General Medicine , UFR Sciences de Santé, University of Burgundy , Dijon, France
| | - Claire Zaba
- a Department of General Medicine , UFR Sciences de Santé, University of Burgundy , Dijon, France
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Shimada YJ, Tsugawa Y, Camargo CA, Brown DFM, Hasegawa K. Effect of Bariatric Surgery on Emergency Department Visits and Hospitalizations for Atrial Fibrillation. Am J Cardiol 2017; 120:947-952. [PMID: 28734462 PMCID: PMC11061550 DOI: 10.1016/j.amjcard.2017.06.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 05/23/2017] [Accepted: 06/13/2017] [Indexed: 01/24/2023]
Abstract
Atrial fibrillation (AF) and obesity are major health problems in the United States. However, little is known about whether bariatric surgery affects AF-related morbidities. This study investigated whether bariatric surgery is associated with short-term and long-term changes in the risk of emergency department (ED) visits or hospitalizations for AF. We performed a self-controlled case series study of obese adults with AF who underwent bariatric surgery by using population-based ED and inpatient databases in California, Florida, and Nebraska from 2005 to 2011. The primary outcome was ED visit or hospitalization for AF. We used conditional logistic regression to compare each patient's risk of the outcome event during sequential 12-month periods, using presurgery months 13 to 24 as a reference period. Our sample consisted of 523 obese adults with AF who underwent bariatric surgery. The median age was 57 years (interquartile range 48 to 64 years), 59% were female, and 84% were non-Hispanic white. During the reference period, 15.9% (95% confidence interval [CI] 12.7% to 19.0%) of patients had an ED visit or hospitalization for AF. The risk remained similar in the subsequent 12-month presurgery period (adjusted OR [aOR] 1.29 [95% CI, 0.94 to 1.76] p = 0.11). In contrast, the risk significantly increased within 12 months after bariatric surgery (aOR 1.53 [95% CI 1.13 to 2.07] p = 0.006). The risk remained elevated during 13-24 months after bariatric surgery (aOR 1.41 [95% CI, 1.03 to 1.91] p = 0.03). In conclusion, this population-based study demonstrated that bariatric surgery was associated with an increased risk of AF episodes requiring an ED visit or hospitalization for at least 2 years after surgery among obese patients with AF.
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Affiliation(s)
- Yuichi J Shimada
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Yusuke Tsugawa
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David F M Brown
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Shimada YJ, Tsugawa Y, Iso H, Brown DFM, Hasegawa K. Association of bariatric surgery with risk of acute care use for hypertension-related disease in obese adults: population-based self-controlled case series study. BMC Med 2017; 15:161. [PMID: 28830535 PMCID: PMC5568280 DOI: 10.1186/s12916-017-0914-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 07/11/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hypertension carries a large societal burden. Obesity is known as a risk factor for hypertension. However, little is known as to whether weight loss interventions reduce the risk of hypertension-related adverse events, such as acute care use (emergency department [ED] visit and/or unplanned hospitalization). We used bariatric surgery as an instrument for investigating the effect of large weight reduction on the risk of acute care use for hypertension-related disease in obese adults with hypertension. METHODS We performed a self-controlled case series study of obese patients with hypertension who underwent bariatric surgery using population-based ED and inpatient databases that recorded every bariatric surgery, ED visit, and hospitalization in three states (California, Florida, and Nebraska) from 2005 to 2011. The primary outcome was acute care use for hypertension-related disease. We used conditional logistic regression to compare each patient's risk of the outcome event during sequential 12-month periods, using pre-surgery months 13-24 as the reference period. RESULTS We identified 980 obese patients with hypertension who underwent bariatric surgery. The median age was 48 years (interquartile range, 40-56 years), 74% were female, and 55% were non-Hispanic white. During the reference period, 17.8% (95% confidence interval [CI], 15.4-20.2%) had a primary outcome event. The risk remained unchanged in the subsequent 12-month pre-surgery period (18.2% [95% CI, 15.7-20.6%]; adjusted odds ratio [aOR] 1.02 [95% CI, 0.83-1.27]; P = 0.83). In the first 12-month period after bariatric surgery, the risk significantly decreased (10.5% [8.6-12.4%]; aOR 0.58 [95% CI, 0.45-0.74]; P < 0.0001). Similarly, the risk remained significantly reduced in the 13-24 months after bariatric surgery (12.9% [95% CI, 10.8-15.0%]; aOR 0.71 [95% CI, 0.57-0.90]; P = 0.005). By contrast, there was no significant reduction in the risk among obese patients who underwent non-bariatric surgery (i.e., cholecystectomy, hysterectomy, spinal fusion, or mastectomy). CONCLUSIONS In this population-based study of obese adults with hypertension, we found that the risk of acute care use for hypertension-related disease decreased by 40% after bariatric surgery. The data provide the best evidence on the effectiveness of substantial weight loss on hypertension-related morbidities, underscoring the importance of discussing options for weight reduction when treating obese patients with hypertension.
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Affiliation(s)
- Yuichi J Shimada
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Gray/Bigelow 800, Boston, MA, 02114, USA.
| | - Yusuke Tsugawa
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 1-1 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - David F M Brown
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
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Kerwin EM, Ferro TJ, Ariely R, Irwin DE, Parikh R. Real-world health care utilization in asthma patients using albuterol sulfate inhalation aerosol (ProAir ® HFA) with and without integrated dose counters. J Asthma Allergy 2017; 10:171-179. [PMID: 28553127 PMCID: PMC5440041 DOI: 10.2147/jaa.s130836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Accurate tracking of the administered dose of asthma rescue inhalers is critical for optimal disease management and is related to reductions in rates of unscheduled health care utilization in asthma patients. There are few published data on the real-world impact of rescue inhalers with integrated dose counters (IDCs) on health care resource utilization (HRU) for asthma patients. This study evaluates HRU among users of ProAir® hydrofluoroalkane (HFA) (albuterol sulfate inhalation aerosol), with IDC versus without IDC, in asthma patients. Methods This was a retrospective administrative claims study of asthma patients receiving a new prescription for albuterol inhalation aerosol without IDC during 2 years (January 2011–December 2012) or with IDC during the first full year after IDC implementation in the USA (July 2013–July 2014). Six months of continuous enrollment with medical and prescription drug benefits were required before and after the first prescription during the study period. Data on respiratory-related hospitalizations and emergency department (ED) visits were collected during the follow-up period. Results A total of 135,305 (32%) patients used albuterol inhalation aerosol with IDC, and 287,243 (68%) patients received albuterol inhalation aerosol without IDC. After adjusting for baseline confounding factors, the odds ratio (OR) for experiencing a respiratory-related hospitalization (OR=0.92; 95% confidence interval [CI] 0.88–0.96) or ED visit (OR=0.92; 95% CI 0.90–0.94) was significantly lower among patients using albuterol inhalation aerosol with IDC versus without IDC. Conclusion In a real-world setting, asthma patients using ProAir HFA with IDC experienced significantly fewer hospitalizations and ED visits compared with patients using ProAir HFA without IDC. Dosage information provided by IDCs may allow providers to better understand patients’ disease severity and aid in titrating controller medications and also decrease the likelihood that the canister will be empty when needed, thereby enhancing disease management and reducing HRU.
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Affiliation(s)
- Edward M Kerwin
- Clinical Trials Division, Clinical Research Institute of Southern Oregon, PC, Medford, OR
| | | | - Rinat Ariely
- Global Health Economics and Outcome Research, Teva Pharmaceuticals, Frazer, PA
| | - Debra E Irwin
- Outcomes Research, Truven Health Analytics, Durham, NC, USA
| | - Ruchir Parikh
- Global Health Economics and Outcome Research, Teva Pharmaceuticals, Frazer, PA
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Shimada YJ, Tsugawa Y, Iso H, Brown DFM, Hasegawa K. Association between bariatric surgery and rate of hospitalisations for stable angina pectoris in obese adults. Heart 2017; 103:1009-1014. [DOI: 10.1136/heartjnl-2016-310757] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/29/2016] [Accepted: 12/29/2016] [Indexed: 12/13/2022] Open
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Hill J, Arrotta N, Villa-Roel C, Dennett L, Rowe BH. Factors associated with relapse in adult patients discharged from the emergency department following acute asthma: a systematic review. BMJ Open Respir Res 2017; 4:e000169. [PMID: 28176972 PMCID: PMC5278313 DOI: 10.1136/bmjresp-2016-000169] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 11/14/2022] Open
Abstract
A significant proportion of patients discharged from the emergency department (ED) with asthma exacerbations will relapse within 4 weeks. This systematic review summarises the evidence regarding relapses and factors associated with relapse in adult patients discharged from EDs after being treated for acute asthma. Following a registered protocol, comprehensive literature searches were conducted. Studies tracking outcomes for adults after ED management and discharge were included if they involved adjusted analyses. Methodological quality was assessed using the Newcastle–Ottawa Scale (NOS) and the Risk of Bias (RoB) Tool. Results were summarised using medians and IQRs or mean and SD, as appropriate. 178 articles underwent full-text review and 10 studies, of various methodologies, involving 32 923 patients were included. The majority of the studies were of high quality according to NOS and RoB Tool. Relapse proportions were 8±3%, 12±4% and 14±6% at 1, 2 and 4 weeks, respectively. Female sex was the most commonly reported and statistically significant factor associated with an increased risk of relapse within 4 weeks of ED discharge for acute asthma. Other factors significantly associated with relapse were past healthcare usage and previous inhaled corticosteroids (ICS) usage. A median of 17% of patients who are discharged from the ED will relapse within the first 4 weeks. Factors such as female sex, past healthcare usage and ICS use at presentation were commonly and significantly associated with relapse occurrence. Identifying patients with these features could provide clinicians with guidance during their ED discharge decision-making.
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Affiliation(s)
- Jesse Hill
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Nicholas Arrotta
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada; School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Cristina Villa-Roel
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Liz Dennett
- John W. Scott Health Sciences Library , University of Alberta , Edmonton, Alberta , Canada
| | - Brian H Rowe
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Alberta Health Services, Edmonton, Alberta, Canada
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Age-Related Differences in the Rate, Timing, and Diagnosis of 30-Day Readmissions in Hospitalized Adults With Asthma Exacerbation. Chest 2016; 149:1021-9. [PMID: 26836926 DOI: 10.1016/j.chest.2015.12.039] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/10/2015] [Accepted: 12/22/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Reducing hospital readmissions has attracted attention from many stakeholders. However, the characteristics of 30-day readmissions after asthma-related hospital admissions in adults are not known. It is also unclear whether older adults are at higher risk of 30-day readmission. OBJECTIVES To investigate the rate, timing, and principal diagnosis of 30-day readmissions in adults with asthma and to determine age-related differences. METHODS Retrospective cohort study of adults hospitalized for asthma exacerbation using the population-based inpatient samples of three states (California, Florida, and Nebraska) from 2005 through 2011. Patients were categorized into three age groups: younger (18-39 years), middle aged (40-64 years), and older (≥ 65 years) adults. Outcomes were 30-day all-cause readmission rate, timing, and principal diagnosis of readmission. RESULTS Of 301,164 asthma-related admissions at risk for 30-day readmission, readmission rate was 14.5%. Compared with younger adults, older adults had significantly higher readmission rates (10.1% vs 16.5%; OR, 2.15 [95% CI, 2.07-2.23]; P < .001). The higher rate attenuated with adjustment (OR, 1.19 [95% CI, 1.13-1.26]; P < .001), indicating that most of the age-related difference is explained by sociodemographics and comorbidities. For all age groups, readmission rate was highest in the first week after discharge and declined thereafter. Overall, only 47.1% of readmissions were assigned respiratory diagnoses (asthma, COPD, pneumonia, and respiratory failure). Older adults were more likely to present with nonrespiratory diagnoses (41.7% vs 53.8%; P < .001). CONCLUSIONS After asthma-related admission, 14.5% of patients had 30-day readmission with wide range of principal diagnoses. Compared with younger adults, older adults had higher 30-day readmission rates and proportions of nonrespiratory diagnoses.
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Hasegawa K, Stoll SJ, Ahn J, Kysia RF, Sullivan AF, Camargo CA. Association of Insurance Status with Severity and Management in ED Patients with Asthma Exacerbation. West J Emerg Med 2016; 17:22-7. [PMID: 26823926 PMCID: PMC4729414 DOI: 10.5811/westjem.2015.11.28715] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 11/02/2015] [Accepted: 11/17/2015] [Indexed: 02/07/2023] Open
Abstract
Introduction Previous studies have demonstrated an association of low socioeconomic status with frequent asthma exacerbations. However, there have been no recent multicenter efforts to examine the relationship of insurance status – a proxy for socioeconomic status – with asthma severity and management in adults. The objective is to investigate chronic and acute asthma management disparities by insurance status among adults requiring emergency department (ED) treatment in the United States. Methods We conducted a multicenter chart review study (48 EDs in 23 U.S. states) on ED patients, aged 18–54 years, with acute asthma between 2011 and 2012. Each site underwent training (lecture, practice charts, certification) before reviewing randomly selected charts. We categorized patients into three groups based on their primary health insurance: private, public, and no insurance. Outcome measures were chronic asthma severity (as measured by ≥2 ED visits in one-year period) and management prior to the index ED visit, acute asthma management in the ED, and prescription at ED discharge. Results The analytic cohort comprised 1,928 ED patients with acute asthma. Among these, 33% had private insurance, 40% had public insurance, and 27% had no insurance. Compared to patients with private insurance, those with public insurance or no insurance were more likely to have ≥2 ED visits during the preceding year (35%, 49%, and 45%, respectively; p<0.001). Despite the higher chronic severity, those with no insurance were less likely to have guideline-recommended chronic asthma care – i.e., lower use of inhaled corticosteroids (ICS [41%, 41%, and 29%; p<0.001]) and asthma specialist care (9%, 10%, and 4%; p<0.001). By contrast, there were no significant differences in acute asthma management in the ED – e.g., use of systemic corticosteroids (75%, 79%, and 78%; p=0.08) or initiation of ICS at ED discharge (12%, 12%, and 14%; p=0.57) – by insurance status. Conclusion In this multicenter observational study of ED patients with acute asthma, we found significant discrepancies in chronic asthma severity and management by insurance status. By contrast, there were no differences in acute asthma management among the insurance groups.
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Affiliation(s)
- Kohei Hasegawa
- Massachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Samantha J Stoll
- North Shore Medical Center, Department of Emergency Medicine, Salem, Massachusetts
| | - Jason Ahn
- Massachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Rashid F Kysia
- John H. Stroger Jr. Hospital of Cook County, Department of Emergency Medicine, Chicago, Illinois
| | - Ashley F Sullivan
- Massachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Carlos A Camargo
- Massachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
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Goto T, Tsugawa Y, Camargo CA, Hasegawa K. Sex differences in the risk of hospitalization among patients presenting to US emergency departments with asthma exacerbation, 2010-2012. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:149-51.e2. [DOI: 10.1016/j.jaip.2015.11.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/01/2015] [Accepted: 11/16/2015] [Indexed: 11/28/2022]
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Goto T, Yoshida K, Tsugawa Y, Camargo CA, Hasegawa K. Infectious Disease-Related Emergency Department Visits of Elderly Adults in the United States, 2011-2012. J Am Geriatr Soc 2015; 64:31-6. [PMID: 26696501 DOI: 10.1111/jgs.13836] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the frequency of infectious disease (ID)-related emergency department (ED) visits of elderly adults in the United States. DESIGN Cross-sectional analysis. SETTING Nationwide emergency department sample in 2011-12. PARTICIPANTS Individuals in the ED aged 65 and older with a primary diagnosis of an ID. MEASUREMENTS ID-related ED visits, hospitalizations, hospital-based mortality. RESULTS During 2012, a weighted estimate of 3,123,909 ED visits for IDs was calculated in elderly U.S. adults. This accounted for 13.5% (3.1 million visits) of all ED visits of elderly adults; this burden was higher than that for myocardial infarction and congestive heart failure combined. The rate of ID-related ED visits was 7,231 per 100,000 elderly adults. The most-common diagnoses were lower respiratory infections (26.2%; 95% confidence interval (CI)=25.7-26.6%), urinary tract infections (25.3%, 95% CI=25.0-25.7%), and septicemia (18.9%, 95% CI=18.3-19.6%). Of all ID-related ED visits, 1,786,657 (57.2%, 95% CI=56.6-57.7%) resulted in hospitalization. The leading cause of hospitalization was septicemia, accounting for 32.2% (95% CI=31.1-33.3%) of all ID-related hospitalizations through EDs, followed by lower respiratory infections (27.8%, 95% CI=27.2-28.4%). Overall, 123,894 individuals (4.0%, 95% CI=3.8-4.1%) died during their ED visit or hospitalization. Of these, septicemia was the leading cause of mortality (74.7%, 95% CI=73.8-75.6%), followed by lower respiratory infections (15.2%, 95% CI=14.6-15.9%). Analysis of the 2011 data gave similar results for the burden of ID-related ED visits, hospitalizations, and mortality. CONCLUSION Using a nationally representative sample, it was found that the public health burden of IDs in elderly U.S. adults was substantial, as measured by ED visits, subsequent hospitalizations, and hospital-based mortality.
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Affiliation(s)
- Tadahiro Goto
- Department of Emergency Medicine, University of Fukui Hospital, Fukui, Japan.,Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kazuki Yoshida
- Department of Epidemiology, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Yusuke Tsugawa
- Harvard Interfaculty Initiative in Health Policy, Harvard University, Boston, Massachusetts
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Chronic Comorbidities Contribute to the Burden and Costs of Persistent Asthma. Mediators Inflamm 2015; 2015:819194. [PMID: 26783384 PMCID: PMC4691464 DOI: 10.1155/2015/819194] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/25/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND We aimed to study the prevalence of chronic comorbidities in asthma patients and the costs of health care use associated with asthma with comorbidities. MATERIAL AND METHODS We analysed the prevalence of the four most common chronic diseases in asthma patients in 2008-2014 in Finland. Prevalence of coronary artery disease, diabetes and dyslipidaemia, hypertension, epilepsy, inflammatory bowel disease, rheumatic diseases, and severe psychiatric disease was studied by register of the Social Insurance Institution of Finland. The costs of health care services were collected from the registries maintained by the National Institute for Health and Welfare (THL). RESULTS Prevalence of asthma was 4.6% in 2014. Diabetes was among the four most common comorbidities in all the age groups. The other common comorbidities were hypertension (≥46 years; 12.9-37.6%), severe psychiatric disorders (age groups of 16-59 years; 1.4-3.5%), and ischaemic heart disease (≥60 years; 10-25%). In patients with both asthma and diabetes, the costs of hospitalization were approximately 169% compared with patients with asthma alone. CONCLUSIONS Prevalence of asthma increases by tenfold when aging. The comorbidity diversity and rate are age-dependent. Prevalence of diabetes as comorbidity in asthma has increased. Costs of hospitalizations in asthma approximately double with chronic comorbidities.
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Hasegawa K, Tsugawa Y, Chang Y, Camargo CA. Risk of an asthma exacerbation after bariatric surgery in adults. J Allergy Clin Immunol 2015; 136:288-94.e8. [DOI: 10.1016/j.jaci.2014.12.1931] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/02/2014] [Accepted: 12/31/2014] [Indexed: 01/19/2023]
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Children and Adults With Frequent Hospitalizations for Asthma Exacerbation, 2012-2013: A Multicenter Observational Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:751-8.e1. [PMID: 26028297 DOI: 10.1016/j.jaip.2015.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 04/02/2015] [Accepted: 05/05/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Earlier studies reported that many patients were frequently hospitalized for asthma exacerbation. However, there have been no recent multicenter studies to characterize this patient population with high morbidity and health care utilization. OBJECTIVE To examine the proportion and characteristics of children and adults with frequent hospitalizations for asthma exacerbation. METHODS A multicenter chart review study of patients aged 2 to 54 years who were hospitalized for asthma exacerbation at 1 of 25 hospitals across 18 US states during the period 2012 to 2013 was carried out. The primary outcome was frequency of hospitalizations for asthma exacerbation in the past year (including the index hospitalization). RESULTS The cohort included 369 children (aged 2-17 years) and 555 adults (aged 18-54 years) hospitalized for asthma exacerbation. Over the 12-month period, 36% of the children and 42% of the adults had 2 or more (frequent) hospitalizations for asthma exacerbation. Among patients with frequent hospitalizations, guideline-recommended outpatient management was suboptimal. For example, among adults, 32% were not on inhaled corticosteroids at the time of index hospitalization and 75% had no evidence of a previous evaluation by an asthma specialist. At hospital discharge, among adults with frequent hospitalizations who had used no controller medications previously, 37% were not prescribed inhaled corticosteroids. Likewise, during a 3-month postdischarge period, 64% of the adults with frequent hospitalizations were not referred to an asthma specialist. Although the proportion of patients who did not receive these guideline-recommended outpatient care appeared higher in adults, these preventive measures were still underutilized in children; for example, 38% of the children with frequent hospitalizations were not referred to asthma specialist after the index hospitalization. CONCLUSIONS This multicenter study of US patients hospitalized with asthma exacerbation demonstrated a disturbingly high proportion of patients with frequent hospitalizations and ongoing evidence of suboptimal longitudinal asthma care.
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Watase H, Hagiwara Y, Chiba T, Camargo CA, Hasegawa K. Multicentre observational study of adults with asthma exacerbations: who are the frequent users of the emergency department in Japan? BMJ Open 2015; 5:e007435. [PMID: 25922104 PMCID: PMC4420980 DOI: 10.1136/bmjopen-2014-007435] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Emergency department (ED) visits for asthma exacerbation reflect a failure of longitudinal asthma management. However, little is known about the characteristics of patients with frequent ED visits (≥2 visits in a 1-year period). We aimed to characterise the adult patients who frequently presented to the ED for asthma exacerbation in Japan. DESIGN A multicentre chart review study of 23 EDs across Japan. PARTICIPANTS Adults aged 18-54 years who presented to the ED with asthma exacerbation from 2009 to 2011. OUTCOME MEASURES Frequency of ED visits for asthma exacerbation in a 1-year period, including the index ED visit. RESULTS Of the 1002 eligible patients, 218 (22%) had frequent ED visits, accounting for 48% of total ED visits for asthma exacerbation in the 1-year period. Specifically, 12% had 2 ED visits and 10% had ≥3 visits. In these patients, guideline-recommended chronic management was suboptimal. For example, among patients with ≥3 ED visits, only 63% were treated with inhaled corticosteroids and 49% were current smokers. In a multinomial logistic regression model, markers of chronic asthma severity (history of hospitalisation for asthma and use of inhaled corticosteroids) were significantly associated with a higher frequency of ED visits (both p<0.05). CONCLUSIONS This multicentre study in Japan demonstrated that many patients are frequent ED users for asthma exacerbation. We also found that their asthma control management is suboptimal, most likely contributing to worse chronic severity and more frequent ED visits. Further dissemination and adoption of evidence-based guidelines are required to reduce asthma morbidity in this high-risk population.
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Affiliation(s)
- Hiroko Watase
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Yusuke Hagiwara
- Department of Radiology, University of Washington, Seattle, Washington, USA
- Department of Emergency Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Takuyo Chiba
- Department of Radiology, University of Washington, Seattle, Washington, USA
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kohei Hasegawa
- Department of Radiology, University of Washington, Seattle, Washington, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Ojanguren I, Genover T, Muñoz X, Ramon MA, Martínez Moragon E, Morell F. Incidence and Triggers of Asthma Exacerbations Attended in the Emergency Department as a Level of Care Indicator (ASMAB III, 2005 and ASMAB IV, 2011). Arch Bronconeumol 2015; 52:82-7. [PMID: 25910545 DOI: 10.1016/j.arbres.2015.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/15/2015] [Accepted: 02/01/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The identification of asthma exacerbations (AE) seen in emergency departments and in the home is proposed as a parameter of asthma control and for monitoring environmental triggers. PATIENTS AND METHODS All AEs seen in 2005 and 2011 in the reference hospital of the region and in the patients' homes by the Emergency Medical Services were identified. RESULTS The incidence of AE was 1.93/10(6)inhabitants/day during 2005, and 2/10(6)inhabitants/day in 2011. The most common triggers were slow onset common cold of more than 24h duration in 104/219 (47%) AEs in 2005 and 107/220 (49%) in 2011; prior bronchial symptoms with cough, expectoration and fever were recorded in 41/219 (19%) in 2005 and in 57/220 (26%) AEs in 2011. In total, 49% (2005) and 74% (2011) of the AEs had onset more than 24h before admission. CONCLUSIONS No significant differences were observed in the rate of attendance in the emergency department due to AE between 2005 and 2011. The most common triggers were common cold and bronchial symptoms with expectoration and fever. AE had begun more than 24h previously in at least half of cases. These findings appear to suggest that there may be a scope for improvement in the outpatient care of the asthmatic patient.
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Affiliation(s)
- Iñigo Ojanguren
- Servei de Pneumologia, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, España
| | - Teresa Genover
- Centre d'Assistència Primària Sant Rafael, Barcelona, España
| | - Xavier Muñoz
- Servei de Pneumologia, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, España
| | - Maria A Ramon
- Servei de Pneumologia, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
| | | | - Ferran Morell
- Servei de Pneumologia, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, España.
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Hasegawa K, Sullivan AF, Tovar Hirashima E, Gaeta TJ, Fee C, Turner SJ, Massaro S, Camargo CA. A Multicenter Observational Study of US Adults with Acute Asthma: Who Are the Frequent Users of the Emergency Department? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:733-40. [DOI: 10.1016/j.jaip.2014.06.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/19/2014] [Accepted: 06/23/2014] [Indexed: 11/30/2022]
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Using Healthcare Cost and Utilization Project (HCUP) Data for Emergency Medicine Research. Ann Emerg Med 2014; 64:458-60. [DOI: 10.1016/j.annemergmed.2014.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/16/2014] [Accepted: 09/17/2014] [Indexed: 11/20/2022]
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Hasegawa K, Tsugawa Y, Camargo CA, Brown DF. Frequent Utilization of the Emergency Department for Acute Heart Failure Syndrome. Circ Cardiovasc Qual Outcomes 2014; 7:735-42. [DOI: 10.1161/circoutcomes.114.000949] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background—
Although most research on patients with acute heart failure syndrome (AHFS) has focused on readmissions, this may provide an incomplete picture of health-care utilization. We examined the proportion and characteristics of patients with frequent emergency department (ED) visits for AHFS and associated health-care utilization.
Methods and Results—
A retrospective cohort study of adults with at least 1 ED visit for AHFS between 2010 and 2011 was performed, derived from population-based multipayer data of state ED and inpatient databases for 2 large and diverse states, California and Florida. The analytic sample comprised 113 033 patients with 175 491 ED visits for AHFS. During the 1-year follow-up period, 30.8% of patients had ≥2 (frequent) visits, accounting for 55.4% (95% confidence interval, 55.2–55.5%) of all ED visits for AHFS. In the multivariable model, significant predictors of frequent ED visits were non-Hispanic black race, Hispanic ethnicity, Medicaid insurance, and lower median household income (all
P
<0.001). At the visit level, patients with frequent ED visits accounted for 55.0% (95% confidence interval, 54.8–5.3%) of all AHFS hospitalizations via ED. Total charges for AHFS were $3.08 billion (95% confidence interval, $3.03–3.14 billion) in Florida alone; patients with frequent ED visits accounted for 53.3% of total charges (95% confidence interval, 53.2–53.3%).
Conclusions—
In this large cohort study, we found that one third (31%) of ED patients with AHFS had frequent ED visits for this condition and that minority race/ethnicity and lower socioeconomic status were associated with frequent ED visits. Individuals with frequent ED visits accounted for the majority of ED visits, hospitalizations, and hospital charges.
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Affiliation(s)
- Kohei Hasegawa
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston (K.H., C.A.C., D.F.M.B.); Harvard Medical School, Boston, MA (K.H., C.A.C., D.F.M.B.); and Harvard Interfaculty Initiative in Health Policy, Cambridge, MA (Y.T.)
| | - Yusuke Tsugawa
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston (K.H., C.A.C., D.F.M.B.); Harvard Medical School, Boston, MA (K.H., C.A.C., D.F.M.B.); and Harvard Interfaculty Initiative in Health Policy, Cambridge, MA (Y.T.)
| | - Carlos A. Camargo
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston (K.H., C.A.C., D.F.M.B.); Harvard Medical School, Boston, MA (K.H., C.A.C., D.F.M.B.); and Harvard Interfaculty Initiative in Health Policy, Cambridge, MA (Y.T.)
| | - David F.M. Brown
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston (K.H., C.A.C., D.F.M.B.); Harvard Medical School, Boston, MA (K.H., C.A.C., D.F.M.B.); and Harvard Interfaculty Initiative in Health Policy, Cambridge, MA (Y.T.)
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Pai S, Mancuso CA, Loganathan R, Boutin-Foster C, Basir R, Kanna B. Characteristics of asthmatic patients with and without repeat emergency department visits at an inner city hospital. J Asthma 2014; 51:627-32. [PMID: 24588683 PMCID: PMC4138125 DOI: 10.3109/02770903.2014.899604] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Abstract Objective: The objective of this study was to document the frequency and clinical characteristics associated with repeat emergency department (ED) visits for asthma in an inner city population with a high burden of asthma. METHODS During an ED visit for asthma in an inner city hospital ('index visit'), patients completed a valid survey addressing disease and behavioral factors. Hospital records were reviewed for information about ED visits and hospitalizations for asthma during the 12 months before and the 90 days after the index visit. RESULTS One hundred and ninety-two patients were enrolled; the mean age was 42 years, 69% were women, 36% were black, 54% were Latino, 69% had Medicaid, and 17% were uninsured. 100 patients (52%) were treated and released from the ED, 88 patients (46%) were hospitalized, and 4 patients (2%) left against medical advice. During the subsequent 90 days, 64 patients (33%) had at least one repeat ED visit for asthma and 27 (14%) were hospitalized for asthma. In a multivariate model, more past ED visits (OR 1.7, 95% CI 1.4, 2.1; p < 0.0001) and male gender (OR 2.5, 95% CI 1.2, 5.4; p = 0.02) remained associated with having a repeat ED visit. Most patients had the first repeat ED visit within 30 days and 18 returned within only 7 days. Among all patients with a repeat visit, those who were not hospitalized for the index visit were more likely to have a repeat visit within 7 days (37%) compared to those who were hospitalized (17%) (p = 0.05 in multivariate analysis). CONCLUSIONS Repeat ED visits were prevalent among inner city asthma patients and most occurred shortly after the index visit. The strongest predictors of repeat visits were male gender and more ED visits in the 12 months before the index visit.
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Affiliation(s)
- Sucheta Pai
- Department of Internal Medicine, Weill Cornell Medical College , New York, NY , USA
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Hasegawa K, Brenner BE, Clark S, Camargo CA. Emergency department visits for acute asthma by adults who ran out of their inhaled medications. Allergy Asthma Proc 2014; 35:42-50. [PMID: 24801458 DOI: 10.2500/aap.2014.35.3747] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study was designed to determine the percentage of asthma-related emergency department (ED) visits made by patients who recently ran out of their inhaled short-acting beta-agonists or inhaled corticosteroids and to characterize this understudied patient population. A secondary analysis was performed of data from four ED-based multicenter studies of acute asthma during 1996-1998 (n = 64 EDs). In each study, consecutive adult patients, aged 18-54 years, with acute asthma underwent a structured interview that assessed running out of inhaled medications. The analytic cohort comprised 1095 adults. Overall, 324 patients (30%; 95% confidence interval [CI], 27-32%) ran out of either of their inhaled beta-agonists or inhaled corticosteroids during the week before their index ED visit; 311 (28%; 95% CI, 26-31%) ran out of inhaled beta-agonists per se. Among a subset of 518 patients on inhaled corticosteroids, 55 patients (11%; 95% CI, 8-14%) ran out of inhaled corticosteroids. In the multivariable model, predictors of running out of an asthma medication were male sex, non-Hispanic black race, Hispanic ethnicity, no insurance, lower household income, and use of EDs as the preferred source of asthma prescriptions (all p < 0.05). Among patients who ran out of medications, 49% (95% CI, 43-55%) ran out of inhaled beta-agonists and 72% (95% CI, 58-84%) ran out of inhaled corticosteroids, before onset of their acute asthma symptoms. In 1095 adult ED patients with acute asthma, we found that 30% ran out of their inhaled asthma medications before the ED visit. Asthma patients who ran out of medications had sociodemographic characteristics that may help with identification of preventable ED visits. Multifaceted strategies needed to ensure optimal use of inhaled medications are warranted.
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Affiliation(s)
- Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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