Abstract
Background/Aims The Metabolic Syndrome (MetS) increases risk for development of CVD and all-cause mortality, even before disease is clinically apparent (Malik et al. 2004; Lakka et al. 2002; Hu et al. 2004). It is not known whether patients with MetS are at increased risk for hospitalization or readmissions before a catastrophic event occurs. We set out to 1) compare risk for ER visits, hospitalizations, and readmissions between patients with MetS to those without MetS in a large integrated healthcare system, and 2) analyze the role of individual traits comprising MetS as predictors of ER visits, hospitalizations, and readmissions.
Methods This retrospective cohort study utilized EMR and billing data from 2005–2009 to identify subjects 35 years or older with MetS (text searches for its components) and without MetS, but without known CVD. The relationship of the 5 traits of MetS with hospitalization was assessed using modified National Cholesterol Education Program (NCEP ATP II) guidelines. Poisson regression models and logistic regression models were used to compare MetS to No MetS groups in terms of number of ER visits and hospitalizations in years, and admission, readmission, and 30-day readmission rates.
Results Patients with MetS had a significantly higher number of ER visits (0.47± 1.52 vs. 0.32±1.02, p-value <0.0001), higher number of hospitalizations (0.16± 0.52 vs. 0.09±0.45, p-value < 0.0001), and higher admission rates (11.99% (276 of 2302) vs. 6.84%(384 of 5612), p-value <0.0001), when compared to No MetS group. Survival analysis on time to first ER visit and hospitalization show that MetS group had a higher risk of having an ER visit (HR 1.262 (1.127–1.414), p<0.0001) and a hospitalization (HR 1.686 (1.444–1.968), p<0.0001) than No MetS group. Subjects with 0 MetS traits had a 6% (95 of 1665) admission rate, compared to 18% (31 of 173) for those with 5 traits, increasing linearly with increasing number of traits (P-value < 0.0001).
Conclusions Patients with traits defining the MetS are at increased risk for ER visits and hospitalizations even before they develop established CVD. Interventions targeting this specific population may prevent disease exacerbation, improve patient outcomes, and reduce healthcare utilization associated with the MetS traits.
