National trends in emergency conditions through the Omicron COVID‐19 wave in commercial and Medicare Advantage enrollees

Objective To evaluate trends in emergency care sensitive conditions (ECSCs) from pre‐COVID (March 2018–February 2020) through Omicron (December 2021–February 2022). Methods This cross‐sectional analysis evaluated trends in ECSCs using claims (OptumLabs Data Warehouse) from commercial and Medicare Advantage enrollees. Emergency department (ED) visits for ECSCs (acute appendicitis, aortic aneurysm/dissection, cardiac arrest/severe arrhythmia, cerebral infarction, myocardial infarction, pulmonary embolism, opioid overdose, pre‐eclampsia) were reported per 100,000 person months from March 2018 to February 2022 by pandemic wave. We calculated the percent change for each pandemic wave compared to the pre‐pandemic period. Results There were 10,268,554 ED visits (March 2018−February 2022). The greatest increases in ECSCs were seen for pulmonary embolism, cardiac arrest/severe arrhythmia, myocardial infarction, and pre‐eclampsia. For commercial enrollees, pulmonary embolism visit rates increased 22.7% (95% confidence interval [CI], 18.6%–26.9%) during Waves 2−3, 37.2% (95% CI, 29.1%–45.8%] during Delta, and 27.9% (95% CI, 20.3%–36.1%) during Omicron, relative to pre‐pandemic rates. Cardiac arrest/severe arrhythmia visit rates increased 4.0% (95% CI, 0.2%–8.0%) during Waves 2−3; myocardial infarction rates increased 4.9% (95% CI, 2.1%–7.8%) during Waves 2−3. Similar patterns were seen in Medicare Advantage enrollees. Pre‐eclampsia visit rates among reproductive‐age female enrollees increased 31.1% (95% CI, 20.9%–42.2%), 23.7% (95% CI, 7.5%,–42.3%), and 34.7% (95% CI, 16.8%–55.2%) during Waves 2−3, Delta, and Omicron, respectively. ED visits for other ECSCs declined or exhibited smaller increases. Conclusions ED visit rates for acute cardiovascular conditions, pulmonary embolism and pre‐eclampsia increased despite declines or stable rates for all‐cause ED visits and ED visits for other conditions. Given the changing landscape of ECSCs, studies should identify drivers for these changes and interventions to mitigate them.