# Emergency Department Visits for Circulatory System Diseases: A Study of Primary Diagnoses Using National Hospital Ambulatory Medical Care Survey (NHAMCS) Data From 2016 to 2022

## TL;DR

This study analyzed emergency department visits for circulatory diseases in the U.S. from 2016 to 2022, finding rising rates followed by stabilization and highlighting disparities by age, race, and insurance.

## Contribution

The study provides updated national trends and disparities in ED visits for circulatory diseases using recent NHAMCS data.

## Key findings

- ED visit rates for circulatory diseases increased from 2016 to 2019, declined in 2020, and stabilized in 2021-2022.
- Hypertension-related conditions and acute ischemic events were the most common primary diagnoses.
- Non-Hispanic Black individuals and older adults had significantly higher ED visit rates compared to other groups.

## Abstract

Background: Circulatory system diseases are leading causes of emergency department (ED) visits in the United States. Understanding trends in these visits is crucial for healthcare planning.

Objective: This study aimed to identify the most frequent primary circulatory system diagnoses presenting to EDs, examine temporal trends in ED visit rates from 2016 to 2022, and assess disparities by patient age, sex, race/ethnicity, insurance status, and geographic region.

Materials and methods: A cross-sectional analysis of the National Hospital Ambulatory Medical Care Survey (NHAMCS) data (2016-2022) identified ED visits with a primary circulatory disease diagnosis using International Classification of Diseases (ICD) codes. Weighted estimates ensured national representativeness. Descriptive statistics and inferential statistics were used to assess trends. Analyses were performed in STATA 17 (StataCorp., College Station, TX, USA) (p<0.05).

Results: Overall ED visit rates for circulatory diseases rose from 15 per 1,000 in 2016 to 17 per 1,000 in 2019 (p<0.01), declined to 16 per 1,000 in 2020 (p<0.05 vs. 2019), and stabilized at 17 per 1,000 in 2021-2022 (no significant change, p=0.12). Essential hypertension (14%), hypertensive heart or kidney disease (13%), acute myocardial infarction (11%), atrial fibrillation/flutter (10%), and ischemic stroke (8%) represented the five most common primary diagnoses, accounting for over 56% of circulatory presentations. Older adults (65+) exhibited the highest visit rates (peaking at 55 per 1,000 in 2022), males had slightly higher rates than females (18 vs. 16 per 1,000 in 2022), and non-Hispanic Black individuals had persistently elevated rates (28 per 1,000 in 2022) compared to non-Hispanic White individuals (17 per 1,000) and Hispanic individuals (12 per 1,000) (all p<0.05). The Midwest and Northeast regions reported the highest rates, whereas the West had the lowest, underscoring geographic variation in circulatory disease burden. Medicare beneficiaries had the highest utilization (44 per 1,000 in 2022), highlighting insurance-related disparities.

Conclusions: In this nationally representative analysis, primary ED presentations for circulatory diseases were dominated by hypertension-related conditions and acute ischemic events. Stabilization of rates post-2020, particularly among older and Medicare-insured patients, indicates potential targets for intervention. Strengthening primary care access and preventive programs, especially for older adults and non-Hispanic Black individuals, may reduce ED reliance and improve equity in cardiovascular care.