Correlation of Initial Echocardiographic Parameters and Emergency Room Admission Rates in Heart Failure Clinic Patients

Purpose The prevalence of heart failure (HF) has increased demand on the healthcare system. Echocardiography is a common non-invasive test in HF patients and is thought to have many clinical prognostic implications. This study sought to identify certain echocardiographic parameters that would act as predictors for relative health care resource utilization in HF patients, by correlating with their annual emergency room visits. Methods We conducted retrospective chart review on patients seen at a high-acuity tertiary care HF clinic. A total of 263 patients’ charts were reviewed and data regarding their initial baseline echocardiogram were recorded. Specific predictors evaluated included baseline ejection fraction (EF), left atrial volume index (LAVI), and tricuspid regurgitation peak gradient (TRPG). Each patient's total number of annual ER visits over one year from their initial referral to the clinic was recorded. Each predictor was analyzed separately and divided into subgroups based on specific clinical guideline cutoff ranges. Patients were divided by EF into two groups, HFpEF (EF>50%) and HFrEF (EF<40%). Presence of pulmonary hypertension was defined as TRPG>31.6 mmHg. Possible diastolic dysfunction was defined by LAVI>34 mL/m2. For each individual predictor, we compared the average annual ER visits between each subgroup. Results There were no significant differences in annual ER visits when using LAVI (p=0.317) or TRPG (p=0.392) alone as a predictor. There was a significant difference in annual ER visits when using EF alone as a predictor, where patients with EF>50% had significantly more annual ER visits compared to patients with EF<40% (p<0.05). However, a major confounder for this difference was age, where HF patients with EF>50% were generally older (p<0.05). Multivariate analysis of all echo parameters also showed significant correlation between EF and ER visits. Conclusion Neither LAVI nor TRPG were found to be a predictor of health care utilization through annual ER visits. Patients with HFpEF (EF>50%) had significantly more annual ER visits compared to patients with HFrEF (EF<40%); this finding has not been previously reported and suggests that patients with HFpEF may have a higher associated morbidity and utilization of health care resources.