Low-Risk Chest Pain Patients: Exploring the Impact of Socioeconomy on Emergency Department Revisits.

Abstract

Background: Patients with chest pain and undetectable high-sensitivity cardiac troponin T (hs-cTnT) in the emergency department (ED) have a low short-term risk of cardiovascular events, but the frequency of ED revisits in this group is unknown. This study investigated the associations between disposable income and risk of ED revisits in patients with chest pain and undetectable hs-cTnT.

Methods: All first visits to 7 EDs in Sweden from 2010 to 2017 by patients with chest pain and hs-cTnT <5 ng/l were included. Incidence rate ratios (IRR) were calculated to estimate the ED revisit risk in relation to disposable income according to data obtained from Swedish government agencies (Statistics Sweden).

Results: Altogether, 61,539 patients with a first ED visit were included, in whom 126,650 revisits occurred. The adjusted 30-day risk of a revisit was 1.3- (IRR 1.32, 95% CI: 1.23-1.42) and 1.5-fold (IRR 1.50, 95% CI: 1.40-1.60), and for any revisit during the follow-up 1.6- (IRR 1.63, 95% CI: 1.59-1.66) and 1.8-fold (IRR 1.78, 95% CI 1.72-1.79), in patients with middle-low and low versus high income, respectively. During a median follow-up of 6.8 years, 1714 (2.8%) deaths occurred, and the adjusted cumulative incidence of major adverse cardiovascular events at 1 and 5 years was only 0.3% (95% CI: 0.2-0.4%) and 1.1% (95% CI: 0.8-1.4%) higher in patients with the lowest versus highest income levels.

Conclusions: Disposable income level is inversely associated with the risk of ED revisits among patients presenting with chest pain and undetectable hs-cTnT, in whom cardiovascular risks are low.