VARIABILITY IN PREOPERATIVE EMERGENCY UTILIZATIONS IS ASSOCIATED WITH INITIAL PRIMARY PACEMAKER INSERTION

1 online resource (66 pages) : PDF

2016

University of North Carolina at Charlotte

Implantable pacemaker insertions are recommended for treating bradycardia, heart block, or both by the Centers for Medicare and Medicaid, as well as healthcare policy groups, such as the American College of Cardiology and the American Heart Association. The incidence of pacemaker insertions has been steadily rising since the 1980s. Most surgeries are done in an inpatient setting. Bradycardia and heart block, although benign in terms of manifestation and symptom presentation on a regular basis, may present with radical symptoms such as chest pain, fatigue, or syncope without notice and may incite emergency room visits. Incidental chest pain and syncope are leading presenting conditions for emergency room visits in the United States. By way of these known etiologies and facts pertaining to emergency room use, we can justifiably assume that bradycardia and heart block leading to inpatient pacemaker insertions may have patients routing through the emergency room. We hypothesized that patients diagnosed with bradycardia, heart block, or both in the emergency room who have higher preoperative emergency room use may have a greater likelihood of receiving an eventual initial pacemaker in the inpatient setting, relative to patients with the same diagnoses, who do not visit the emergency room as often.This retrospective case-time study used data from the Healthcare Cost and Utilization Project’s (HCUP; an Agency for Healthcare Research and Quality project) State Inpatient Database (SID) and State Emergency Department Database (SEDD) from Florida for 2011 and 2012. Patients were indexed at their first emergency room visit in 2011 and followed through to the first pacemaker insertion in the SID or censored at the end of observation (December 2012 in SID or SEDD). Patients receiving a pacemaker in the -p cases were incidence density matched with controls who did not receive a pacemaker at a 1:4 ratio on age, sex, and time under observation in the study period. Patient demographics and clinical characteristics as well as emergency room use characteristics were compared between cases and controls using descriptive and bivariate statistics. Conditional logistic regressions were used to assess marginal likelihood associated with higher emergency room use in the matched cohort.The matching yielded a well-balanced study design and sampling. Approximately 60% of cases had 2 or more emergency room visits in the observation period, whereas only 33% of the control group had 2 or more emergency room visits in the individual case-matched observation window. Our linear regression models also corroborated the descriptive findings. Patients with higher counts of emergency room visits in the observation period were almost twice as likely to have an eventual pacemaker (OR = 1.754, 95% CI 1.536, 1.957).Study findings helped us to reject the null hypothesis. Higher preoperative emergency room use was indeed associated with a higher likelihood of an eventual pacemaker among patients diagnosed with bradycardia, heart block, or both.

doctoral dissertations

Medical sciences
Health services administration
Surgery

Ph.D.

Health Resource Utilization
Incidence Density Sampling
Pacemaker Insertion
Preoperative Emergency Room Use

Health Services Research

Studnicki, James

Blanchette, Christopher
Tsivitse-Arthur, Susan
de-Moor, Carl
Langford, David

Thesis (Ph.D.)--University of North Carolina at Charlotte, 2016.

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