RESUMEN
Heart failure is a significant public health problem. The epidemiology and practice pattern of emergency department (ED) visits for acute decompensated heart failure (ADHF) have not been well characterized. A better description is essential to highlight areas in which improvements or additional research are needed. We analyzed all ED visits for ADHF of patients>or=40 years old using the data of the National Hospital Ambulatory Medical Care Survey from 1992 to 2001. During this 10-year period, an estimated 10.5 million ED visits occurred for ADHF, representing 2.9% of all ED visits. The number of ADHF visits increased on average by 18,500 per year, for a 19.4% absolute increase during the decade. The rate per 1,000 United States population was unchanged. The average patient was 74 years old, and patients>or=65 years accounted for 79% of visits. Loop diuretics were administered in 63% and vasodilators in 29% of visits. The ED visit rate per 1,000 United States population was 53% higher in blacks than in whites (14.2 vs 9.3). In a multivariate model, white race was a significant predictor of hospitalization. In conclusion, during the past decade, the absolute number of ED visits for ADHF has increased owing to the aging population. Diuretics remain the most common treatment. Race-related differences in hospitalization merit additional study.
Asunto(s)
Servicio de Urgencia en Hospital , Insuficiencia Cardíaca/epidemiología , Hospitalización , Enfermedad Aguda , Adulto , Distribución por Edad , Anciano , Servicio de Urgencia en Hospital/estadística & datos numéricos , Servicio de Urgencia en Hospital/tendencias , Femenino , Hospitalización/estadística & datos numéricos , Hospitalización/tendencias , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVES: To estimate the prevalence of complementary and alternative medicine (CAM) usage among emergency department (ED) patients. METHODS: This study was a cross-sectional study in four Boston-area EDs. For two 24-hour periods, the authors interviewed consecutive patients age 18 and older about whether they had ever used or had recently (within the past year) used CAM "remedies" (e.g., herbal treatments) or "therapies" (e.g., chiropractic). The authors also asked about the patient's disclosure of CAM usage to allopathic health care providers. RESULTS: Of 978 patients, 752 patients were eligible. Among these, 539 (72%) were interviewed. Of these patients, ever having used CAM was reported by 57% (95% CI = 52% to 61%), and 37% (95% CI = 33% to 41%) reported use in the past year. In a multivariate model of recent CAM usage, independent predictors were younger age, higher education level, and chronic pain. Patients who spoke Spanish as their primary language were less likely to report CAM usage. Disclosure of CAM usage to allopathic providers was low, yet >80% reported that they would be comfortable discussing their CAM usage with allopathic providers. CONCLUSIONS: CAM usage was common among ED patients enrolled in our study, despite underreporting to ED staff. Given the growing evidence of benefits and hazards from popular CAM remedies and therapies, ED staff should consider raising this health issue with their patients.