1 in 20 CV Diagnoses Missed in Emergency Departments

As many as 1 in 20 opportunities to diagnose cardiovascular events such as acute myocardial infarction (AMI) and stroke are missed in the emergency department (ED), new research shows.

Although this finding indicates a need for new strategies geared toward reducing diagnostic error in this setting, “further improvement may prove difficult,” the authors wrote.
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They arrived at their conclusion following an analysis of all 2006-2014 Medicare claims data for hospital ED visits, including 1,561,940 Medicare patients who were hospitalized for ruptured abdominal aortic aneurysm (AAA; n = 17,963), AMI (n = 304,980), stroke (n = 1,181,648), aortic dissection (n = 19,675), or subarachnoid hemorrhage (SAH; n = 37,674) between 2007 and 2014.

The proportion of potential diagnostic opportunities missed in the ED was estimated using various factors, including the difference between observed and expected ED discharges within 45 days of index hospital admissions.

Results indicated that the proportions of diagnostic opportunities missed in the ED were 3.4% for ruptured AAA, 2.3% for AMI, 4.1% for stroke, 4.5% for aortic dissection, and 3.5% for SAH.

The researchers noted that longitudinal trends for AAA, stroke, and SAH were increasing, while those for AMI and aortic dissection were nonsignificant.

In addition, they found that unrecognized emergencies were most often associated with age younger than 65 years, dual eligibility for Medicare and Medicaid coverage, female sex, and the presence of chronic conditions such as dementia, diabetes, and depression.

—Christina Vogt

Reference:

Waxman DA, Kanzaria HK, Schriger DL. Unrecognized cardiovascular emergencies among Medicare patients. JAMA Intern Med. 2018;178(4):477-484. doi:10.1001/jamainternmed.2017.8628.