Uncontrolled BP Linked to One Third of ED Visits for CVD

Megan Brooks

September 26, 2022

A look at the top cardiovascular disease (CVD) diagnoses in US emergency departments (EDs) suggests that many heart-related emergencies are due to poorly controlled high blood pressure.

In a study of more than 20 million ED visits, about one third of CVD-related ED visits in the United States were for hypertension-related conditions.

Overall, 13% of ED visits, representing more than 2.7 million individuals, were for essential hypertension.

The fact that these visits rarely led to an inpatient admission (< 3%) or death (< 0.1%) suggests they were "mostly related to the management of hypertension," lead author Mamas A. Mamas, MD, Keele University, England, said in a news release.

The study was published online September 20 in the Journal of the American Heart Association.

Nationwide Sample

The researchers studied more than 20.6 million ED encounters in adults with a primary CVD diagnosis using data from the Nationwide Emergency Department Sample between 2016 and 2018.

The sample was 49% women, and the median age was 67 years. Men had poorer overall baseline cardiometabolic profiles, but women had higher rates of obesity, hypertension, and cerebrovascular disease. The majority had Medicare or Medicaid insurance.

In women, essential hypertension was the most common reason for an ED visit (16%), followed by hypertensive heart or kidney disease (14%) and atrial fibrillation (AF)/flutter (10%).

In men, the top three reasons were hypertensive heart or kidney disease (15%), essential hypertension (11%), and acute myocardial infarction (AMI, 11%).

On presentation, women were significantly more likely to have essential hypertension, hypertensive crisis, AF/flutter, supraventricular tachycardia, pulmonary embolism, or ischemic stroke, while men were more likely to have AMI, or cardiac arrest.

"Previous studies have shown sex differences in patterns of CVD among hospitalized patients," Mamas notes. "However, examining CVD encounters in the ED provides a more complete picture of the cardiovascular healthcare needs of men and women, as it captures encounters prior to hospitalization."

He notes that previous studies of CVD emergency visits are limited to suspected MI visits. "Therefore, this analysis of 15 CVD conditions helps to better understand the full spectrum of acute CVD needs, including sex disparities in hospitalization and risk of death," Mamas said.

Sex Differences in Outcomes

The study also found that outcomes from the emergency CVD visits were slightly different for men and women.

Overall, women were less likely than men to die (3.3% vs 4.3%) or be hospitalized (49.1% vs 52.3%) after an ED visit for CVD. The difference may be due to women's generally lower-risk diagnoses, Mamas said, but there could be an underestimation of deaths in women.

In logistic regression models adjusted for baseline covariates, women with intracranial hemorrhage (ICH) had a higher risk of being admitted to hospital or dying compared with men with ICH.

Men were more likely to die if they presented with hypertensive heart or kidney disease, AF/flutter, AMI or cardiac arrest, the researchers found. 

"We did not track deaths outside of the hospital setting," Mamas points out. Given past evidence that women are more likely to be inappropriately discharged from the ED, and strong evidence for the systemic under-treatment of women, further study is warranted to track outcomes beyond the ED visit," he adds.

The researchers call for further research into understanding the underlying factors driving the differences in CVD patterns and outcomes between men and women.

Reached for comment, Maryann McLaughlin, MD, a cardiologist at Mount Sinai Hospital, New York City, said: "Hypertension is a silent killer" and this study "reiterates that people need to get their blood pressure checked more regularly."

"In the very least, if they do present to the hospital as not feeling well or whatever it is, and they are identified as having high blood pressure, that's an important opportunity to really teach them about hypertension and have them follow-up with it," McLaughlin told theheart.org | Medscape Cardiology

The study was supported by Health Data Research UK. Keele and McLaughlin have reported no relevant financial relationships.

J Am Heart Assoc. Published online September 8, 2022. Abstract

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