All-cause emergency department visits and hospitalizations in persons with rheumatoid arthritis: A systematic review.

BACKGROUND: Despite advances in the management of rheumatoid arthritis (RA), acute care services are still frequently accessed. The magnitude of use and variations related to methodology, health system, and personal characteristics is unknown. This review sought to synthesize the literature on the frequency of all-cause acute care use among RA cohorts in the contemporary context. METHODS: A systematic review was conducted in 2 electronic databases over a 25-year period using predefined concept blocks for RA and acute care. Primary outcomes were the rate (cases per 100 person-years) or proportion (percent of a cohort with an acute care event) of all-cause emergency department visits or hospitalizations with a priori stratification by admission type and observation period. Substantial between-study heterogeneity, largely driven by variability in study-level inclusion criteria precluded meta-analysis; therefore, findings were summarized using box-and-whisker plots and narrative synthesis. RESULTS: Ninety articles reporting data from 113 cohorts were included. Acute care use was consistently high in RA compared to matched non-RA cohorts. Within RA cohorts, hospital readmissions occurring after an index event were the greatest source of use (up to 161/100py), followed by emergency department visits (up to 94/100py), and then index hospital admissions (up to 71/100py). CONCLUSION: Heterogeneity of estimates of all-cause acute care use in RA cohorts is considerable. Further understanding of the reasons for acute care use, impacts of health system structure, and geographic differences is needed.