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Fragoulis C, Polyzos D, Mavroudis A, Tsioufis PA, Kasiakogias A, Leontsinis I, Mantzouranis E, Kalos T, Sakalidis A, Ntalakouras J, Andrikou I, Dimitriadis K, Konstantinidis D, Thomopoulos C, Tsioufis K. One-year outcomes following a hypertensive urgency or emergency. Eur J Intern Med 2024; 120:107-113. [PMID: 37872037 DOI: 10.1016/j.ejim.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/06/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023]
Abstract
There are scarce data on the comparative prognosis between patients with hypertensive emergencies (HE), urgencies (HU), and those without HU or HE (HP). Our study aimed to compare cardiovascular (CV) outcomes of HE, HU, and HP during a 12-month follow-up period. The population consisted of 353 consecutive patients presenting with HE or HU in a third-care emergency department and subsequently referred to our hypertension center for follow-up. After both groups completed scheduled follow-up visits, patients with HU were matched one-to-one by age, sex, and hypertension history with HP who attended our hypertension center during the same period. Primary outcomes were 1) a recurrent hypertensive HU or HE event and 2) non-fatal CV events (coronary heart disease, stroke, heart failure, or CV interventions), while secondary outcomes were 1) all-cause death, 2) CV death, 3) non-CV death, and 4) any-cause hospitalization. Events were prospectively registered for all three groups. During the study period, 81 patients were excluded for not completing follow-up. Among eligible patients(HE = 94; HU = 178), a total of 90 hospitalizations and 14 deaths were recorded; HE registered greater CV morbidity when compared with HU (29 vs. 9, HR 3.43, 95 % CI 1.7-6.9, p = 0.001), and increased CV mortality (8 vs. 1, HR 13.2, 95 % CI 1.57-110.8, p = 0.017). When opposing HU to HP, events did not differ substantially. Cox regression models were adjusted for age, sex, CV and chronic kidney disease, diabetes mellitus, and smoking. During 1-year follow-up, the prognosis of HU was better than HE but not different compared to HP. These results highlight the need for improved care of HU and HE.
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Affiliation(s)
- Christos Fragoulis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Dimitrios Polyzos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Andreas Mavroudis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Panagiotis-Anastasios Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Alexandros Kasiakogias
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Ioannis Leontsinis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Emmanouil Mantzouranis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Theodoros Kalos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Athanasios Sakalidis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - John Ntalakouras
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Ioannis Andrikou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Kyriakos Dimitriadis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Dimitris Konstantinidis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Costas Thomopoulos
- Department of Cardiology, Helena Venizelou Hospital, 2 Helena Venizelou Street, 11521 Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece.
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Ashraf M, Zlochiver V, Bolton A, Allaqaband SQ, Bajwa T, Jan MF. Thirty-Day Readmission Rate Among Patients With Hypertensive Crisis: A Nationwide Analysis. Am J Hypertens 2022; 35:852-857. [PMID: 35869656 DOI: 10.1093/ajh/hpac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/20/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Hypertensive crisis is a life-threatening condition, further classified as hypertensive emergency and hypertensive urgency based on the presence or absence of acute or progressive end-organ damage, respectively. Readmissions in hypertensive emergency have been studied before. We aimed to analyze 30-day readmissions using recent data and more specific ICD-10-CM coding in patients with hypertensive crisis. METHODS In a retrospective study using the National Readmission Database 2018, we collected data on 129,239 patients admitted with the principal diagnosis of hypertensive crisis. The primary outcome was the all-cause 30-day readmission rate. Secondary outcomes were common causes of readmission, in-hospital mortality, resource utilization, and independent predictors of readmission. We also compared outcomes between patients with hypertensive urgency and hypertensive emergency. RESULTS Among 128,942 patients discharged alive, 13,768 (10.68%) were readmitted within 30 days; the most common cause of readmission was hypertensive crisis (19%). In-hospital mortality for readmissions (1.5%) was higher than for index admissions (0.2%, P < 0.01). Mean length of stay for readmissions was 4.5 days. The mean hospital cost associated with readmissions was $10,950, and total hospital costs were $151 million. Age <65 years and female sex were independent predictors of higher readmission rates. Subgroup analysis revealed a higher readmission rate for hypertensive emergency than hypertensive urgency (11.7% vs. 10%, P < 0.01). CONCLUSIONS All-cause 30-day readmission rates are high in patients admitted with hypertensive crisis, especially patients with hypertensive emergency. Higher in-hospital mortality and resource utilization are associated with readmission in these patients.
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Affiliation(s)
- Muddasir Ashraf
- Hospital Medicine, UnityPoint Health Clinic Quad Cities, Rock Island, Illinois, USA.,Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Viviana Zlochiver
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin, USA
| | - Alexander Bolton
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA.,Hospital Medicine, UnityPoint Health-St. Luke's Hospital, Cedar Rapids, Iowa, USA
| | - Suhail Q Allaqaband
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin, USA.,Department of Cardiovascular Disease, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Tanvir Bajwa
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin, USA.,Department of Cardiovascular Disease, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - M Fuad Jan
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin, USA.,Department of Cardiovascular Disease, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Giaimo AA, Kang AJ, Huot SJ. Hypertensive Urgency: An Emergency Department Pipeline to Primary Care Pilot Study. Am J Hypertens 2021; 34:291-295. [PMID: 33216142 DOI: 10.1093/ajh/hpaa190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/10/2020] [Accepted: 11/13/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Optimal triage of patients with hypertensive urgency (HU) in the emergency department (ED) is not well established. 2017 ACC/AHA hypertension (HTN) guidelines recommend treatment initiation and follow-up within 1 week. Objectives of our pilot study were to evaluate feasibility and impact of directly connecting ED patients with HU to outpatient HTN management on blood pressure (BP) control and ED utilization. METHODS ED patients with HU and no primary care physician were scheduled by a referral coordinator for an initial appointment in a HTN clinic embedded within a primary care practice. BP control and ED utilization over the subsequent 90 days were tracked and compared with BP at time of the referral ED visit, and ED utilization in the 90 days preceding referral. RESULTS Data are reported for the first 40 referred patients. Average time to first visit was 7.8 days. Mean age was 51 years (range 28-76), 75% were African-American, and mean pooled 10-year atherosclerotic cardiovascular disease (ASCVD) risk was 20.8%. Mean BP declined from 198/116 mm Hg at ED visit to 167/98 mm Hg at HTN clinic visit 1 to 136/83 by 6 weeks and was sustained at 90 days. Total ED visits for the group decreased from 61 in the 90 days prior to referral, to 18 in the 90 days after the first HTN clinic visit. CONCLUSIONS In this pilot study, coordinated referral between the ED and primary care provides safe, timely care for this high ASCVD risk population and leads to sustained reductions in BP and ED utilization.
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Affiliation(s)
- Antonio A Giaimo
- Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Angela J Kang
- Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, Waterbury Hospital, Waterbury, Connecticut, USA
| | - Stephen J Huot
- Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
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Giakoumis M, Sargsyan D, Kostis JB, Cabrera J, Dalwadi S, Kostis WJ. Readmission and mortality among heart failure patients with history of hypertension in a statewide database. J Clin Hypertens (Greenwich) 2020; 22:1263-1274. [PMID: 33051955 DOI: 10.1111/jch.13918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/27/2020] [Accepted: 06/05/2020] [Indexed: 12/21/2022]
Abstract
Objective was to examine the temporal trends in readmission and mortality of heart failure (HF) patients with history of hypertension. This study includes 51 141 patients with history of hypertension who were discharged with a first diagnosis of HF between January 1, 2000, and December 31, 2014. Data were obtained from the Myocardial Infarction Data Acquisition System (MIDAS), a statewide database of all hospitalizations for cardiovascular (CV) disease in New Jersey. The temporal trends of mortality, rates of HF-specific readmission, and all-cause readmissions up to 1 year after discharge were examined using multivariable logistic regression. The difference in all-cause mortality at 3 years between patients who were readmitted compared to those who were not readmitted at 1 year was examined. The number of patients with history of hypertension and HF remained unchanged during the study period. Male gender, black race, comorbidities, and admission to non-teaching hospitals were predictors of HF readmission and CV mortality (P < .05 for all). Readmission rate for any cause increased during the study period (P < .001) while rates of HF readmissions and mortality remained relatively unchanged. Patients that had been readmitted within a year exhibited a significantly higher 3-year mortality (P < .001). CV mortality among HF patients with history of hypertension did not change significantly between 2000 and 2014, while the rates of all-cause readmission increased. Patients who were readmitted had higher 3-year mortality (P < .001) than those who were not.
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Affiliation(s)
- Michail Giakoumis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Davit Sargsyan
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - John B Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Javier Cabrera
- Department of Statistics, Rutgers University, Piscataway, New Jersey, USA
| | - Sanketkumar Dalwadi
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - William J Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Klang E, Soffer S, Shimon Shahar M, Barash Y, Apter S, Konen E, Zimlichman E, Grossman E. Association of normal systolic blood pressure in the emergency department with higher in-hospital mortality among hypertensive patients. J Clin Hypertens (Greenwich) 2019; 21:1841-1848. [PMID: 31742884 DOI: 10.1111/jch.13727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/17/2019] [Accepted: 09/24/2019] [Indexed: 11/26/2022]
Abstract
Blood pressure is commonly elevated at the hospital emergency department (ED), especially among hypertensive patients. The aim of the study was to determine the association between ED systolic blood pressure (SBP) and in-hospital mortality among hypertensive patients. The authors retrospectively retrieved records of hypertensive patients who were hospitalized during a seven-year period. The authors examined the association between SBP and in-hospital mortality rate, adjusted for demographics, heart rate, comorbidities, laboratory results, and hospital ward. Overall, 96 423 patients were included. Compared to patients with SBP 110-139 mm Hg, the adjusted odds ratios were 4.1 (95% CI, 3.7-4.6) with SBP <90, 1.6 (95% CI, 1.4-1.7) with SBP 90-109, 0.7 (95% CI, 0.6-0.7) with SBP 140-159, 0.7 (95% CI, 0.6-0.7) with SBP 160-179, 0.7 (95% CI, 0.6-0.8) with SBP 180-199, 0.9 (95% CI, 0.7-1.1) with SBP 200-219, and 1.1 (95% CI, 0.7-1.7) with SBP ≥220 mm Hg. Thus, SBP levels of 110-139 mm Hg were associated with higher in-hospital mortality in comparison with elevated SBP up to 200 mm Hg.
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Affiliation(s)
- Eyal Klang
- Department of diagnostic imaging, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Soffer
- Department of diagnostic imaging, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Yiftach Barash
- Department of diagnostic imaging, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sara Apter
- Department of diagnostic imaging, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Konen
- Department of diagnostic imaging, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Zimlichman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Hospital Management, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ehud Grossman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Internal medicine Wing, Sheba Medical Center, Tel-Hashomer, Israel
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Cortés Fernández MDS, Segura J. [Should all hypertensive emergencies be treated in the same way?]. HIPERTENSION Y RIESGO VASCULAR 2019; 36:119-121. [PMID: 31221250 DOI: 10.1016/j.hipert.2019.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
Affiliation(s)
- María Del Señor Cortés Fernández
- Área Átención Integrada de Riesgo Vascular. Servicio de Medicina Interna Sant Joan Despí Moisès Broggi- Hospital General Hospitalet, Consorci Sanitari Integral, Barcelona, España.
| | - Julián Segura
- Servicio de Nefrología. Hospital 12 de Octubre, Madrid, España
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