Emergency Department Visits in the United States for Paroxysmal Supraventricular Tachycardia Are Increasing Among Adults: An Analysis from the Nationwide Emergency Department Sample.
OBJECTIVES: Paroxysmal supraventricular tachycardia (PSVT) is an arrhythmia that may be challenging to diagnose because of its sudden and episodic nature and its presentation, which may be confused with acute anxiety, especially after spontaneous resolution. Prevalence of PSVT in the United States (US), based on projections to the 2018 US Census, was estimated to be as high as 2.1 million patients with an annual incidence of nearly 300,000. Prior studies report significant rates of health-care resource use among newly diagnosed patients with PSVT, but likely do not reflect contemporary acute care utilization in a population with increased PSVT prevalence. In this study, we quantified annual US emergency department (ED) visits for PSVT and examined temporal trends in PSVT across time among adults aged ≥18 years old. METHODS: We used the Nationwide Emergency Department Sample data to identify adults who visited the ED with a primary diagnosis of PSVT (International Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM]: I47.1) from 2016-2019. We used Agency for Healthcare Research and Quality-provided sampling weights to estimate annual ED visit counts in the US overall and by the presence or absence of comorbid atrial fibrillation (AFib)/atrial flutter (AFl). We examined demographic characteristics, calculated annual visit rates per 10,000 US population, and assessed visit trends 2016-2019. Sensitivity analyses were conducted in which ED visits were defined primarily for PSVT when PSVT was the primary diagnosis and the ED visit resulted in hospitalization or when PSVT was the diagnosis in any position, and the visit resulted in discharge. We used Poisson regression, based on 2016-2019 visit increases, to project estimates of PSVT visits through 2030. RESULTS: ED visits for PSVT increased 8.3% over the study period (from 129,219 to 139,992; P < .0001); ED visit rates per 10,000 also increased, from 5.16 ( 95% CI, 4.87-5.45) to 5.46 ( 95% CI, 5.18-5.73; P = .0029). ED visits for PSVT as a proportion of all ED visits also increased significantly (P < .0001). The majority of ED visits in 2019, the final study year (N = 139,992; 95% CI, 132,913-147,070), were for females (59.3%) and individuals aged <65 years (62.6%). Most visits involved patients without secondary diagnoses of AFib/AFl (86.0%; 120,377/139,992); 24.2% resulted in inpatient hospitalizations, and 10.1% incurred observation stays. Sensitivity analyses, including diagnosis in any position, identified an additional 119,914 visits in 2019, for a total of 259,916 ED visits for PSVT, with similar characteristics, but larger proportions of observation stays (19.9%). Based on the rate of change from 2016-2019, annual US ED visits with a primary diagnosis of PSVT are projected to reach nearly 180,000 among adults by 2030. CONCLUSION: ED visits due to PSVT in the US have increased significantly among adults. Outpatient interventions for PSVT that reduce the need for an ED visit may minimize the economic burden of PSVT for patients, providers, and payers.
