Desai NR, Fermann G, Pollack C, Venkatesh A, Hooda N, Jiang X, Sacks N, Holtz A, et al. Emergency department visits for PSVT: An analysis of the HCUP Nationwide Emergency Department Sample. Abstract 391, American College of Emergency Physicians (ACEP) Research Forum, Salt Lake City, UT. Ann Emerg Med 86(3S1):S169; doi: 10.1016/j.annemergmed.2025.06.409, September 2025.
Abstract
Study Objectives: Paroxysmal supraventricular tachycardia (PSVT) is an arrhythmia that may be challenging to diagnose due to its sudden and episodic nature. Based on projections to the 2018 US Census, the prevalence of PSVT in the US was estimated to be as high as 2.1 million patients, with an annual incidence of nearly 300,000. Prior studies report significant increases in healthcare resource use among newly diagnosed PSVT patients but may not fully reflect emergency department (ED) use or provide information on contemporary acute care utilization in a prevalent PSVT population. In this study, we quantified ED visits for PSVT and examined temporal trends in PSVT ED visits across time among United States (US) adults aged 18 years and older. Methods: This retrospective, observational cohort study used the Agency for Healthcare Research and Quality (AHRQ) Healthcare Utilization Project (HCUP) National Emergency Department (NEDS) database from 2016-2019, the most recent years of data unaffected by the COVID-19 pandemic, to examine ED visits with a principal diagnosis of PSVT (ICD-10: I47.1) by adults age ≥18y. We used sampling weights provided by HCUP 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. We also conducted sensitivity analyses for ED visits for which PSVT was recorded as a diagnosis in the second or third coding positions. Further, we used Poisson regression, based on 2016-2019 visit increases, to project estimates of PSVT visits through 2030. Results: There were 139,992 (95% CI: 132,913, 147,070) ED visits with PSVT as the principal diagnosis in 2019. Among principal-position PSVT ED visits, mean age was 57.8y; 62.6% were <65y; 59.3% were female; 24.2% resulted in admission to the same hospital. Similar results were seen for ED visits for principal PSVT without a coded secondary AFib/AFL diagnosis (mean age: 56.2y, 60.7% female), although fewer (18.8%) of that cohort resulted in admission. Total ED visits for PSVT increased over the study period (from 129,219 to 139,992; p <0.0001); 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=0.0029). Sensitivity analyses identified an additional 124,435 ED visits with PSVT as the second or third position diagnosis in 2019. The most commonly coded principal diagnoses for these ED visits included diagnoses that could be consistent with acute presentation of PSVT (eg, chest pain (ICD10: R0789) and palpitations (R079)). Based on the rate of change from 2016-2019, annual ED visits with a principal diagnosis of PSVT are projected to reach nearly 180,000 among US adults by 2030. Conclusion: With ED visits for PSVT significantly increasing among US adults, outpatient interventions for PSVT that reduce the need for an ED visit may minimize the burden of PSVT for patients, providers, and payers.