Low-Risk Chest Pain Patients: Exploring the Impact of Socioeconomy on Emergency Department 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.
Competing Interests: Declaration of competing interest None All authors made substantial contribution to the design of the study protocol and in data analysis. The manuscript was critically revised and finally approved by each author. This paper is not under consideration elsewhere and none of the content has been previously published. All authors have read and approved the manuscript. None of the authors declare any conflict of interest. Included within our manuscript is a conflict-of-interest statement, where we disclose any potential conflicts and affirm that there are none that could have influenced the work reported in this manuscript. We have no previously published figures or materials included in the manuscript, and appropriate citations and acknowledgments have been provided. The study protocol was approved by The Swedish Ethical Review Authority, and the study complied with the principles of the Declaration of Helsinki.
(Copyright © 2024. Published by Elsevier Inc.)