Unrecognized Cardiovascular Emergencies Among Medicare Patients

Area of Science:

• Emergency Medicine
• Patient Safety
• Diagnostic Accuracy

Background:

• Diagnostic error is a significant patient safety concern, necessitating improved measurement tools.
• Emergency departments (EDs) are critical points for diagnosing life-threatening conditions.

Purpose of the Study:

• To estimate the proportion of emergency department (ED) visits for imminent ruptured abdominal aortic aneurysm (AAA), acute myocardial infarction (AMI), stroke, aortic dissection, and subarachnoid hemorrhage (SAH) discharged without diagnosis.
• To evaluate longitudinal trends in these missed diagnostic opportunities.
• To identify patient characteristics associated with these diagnostic errors.

Main Methods:

• Retrospective cohort study using Medicare claims data from 2006-2014.
• Analysis of hospital ED visits in the United States for specific critical conditions.
• Estimation of missed diagnostic opportunities based on observed vs. expected ED discharges within 45 days of hospital admission.

Main Results:

• The study analyzed over 1.5 million patient records for ruptured AAA, AMI, stroke, aortic dissection, and SAH.
• Missed diagnostic opportunities ranged from 2.3% for AMI to 4.5% for aortic dissection.
• Trends showed increases for ruptured AAA, stroke, and SAH, while AMI and aortic dissection trends were non-significant.
• Younger age, dual Medicare/Medicaid eligibility, female sex, and various chronic conditions were associated with missed diagnoses.

Conclusions:

• Missed diagnostic opportunities for critical conditions in the ED are relatively infrequent among Medicare patients, occurring in less than 5% of cases.
• While overall rates are low, some conditions show increasing trends, and specific patient demographics are at higher risk.
• Further improvements in diagnostic accuracy for these conditions in the ED may be difficult to achieve.