Key result
Low income is linked to ~50% higher 30-day ED revisit risk in patients with undetectable hs-cTnT.
Why the study?
Patients with chest pain and undetectable hs-cTnT have low short-term cardiovascular risk, but their frequency of emergency department revisits is unknown.
Does lower disposable income increase the risk of emergency department revisits in low-risk patients presenting with chest pain and undetectable hs-cTnT?
Cohort (n=61,539)
Yes
Does lower disposable income increase the risk of emergency department revisits in low-risk patients presenting with chest pain and undetectable hs-cTnT?
Effect estimate: IRR 1.50 (95% CI 1.40-1.60)
Lower disposable income is associated with a significantly higher risk of emergency department revisits among low-risk chest pain patients, despite a low overall risk of cardiovascular events.
May warrant attention to income-related barriers at discharge; leaves open whether addressing disparities reduces revisits.
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.
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Kadesjö et al. (2024) conducted a cohort in Chest pain with undetectable hs-cTnT (n=61,539). Low disposable income vs. High disposable income was evaluated on 30-day risk of ED revisit (IRR 1.50, 95% CI 1.40-1.60). Low disposable income was associated with a 1.5-fold higher 30-day risk of ED revisits (IRR 1.50; 95% CI 1.40-1.60) compared to high income among patients with chest pain and undetectable hs-cTnT.
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