A Population-Based Analysis of Outcomes in Patients With a Primary Diagnosis of Hypertension in the Emergency Department - 25/08/16

Doi : 10.1016/j.annemergmed.2016.04.060

Sameer Masood, MD ^a, Peter C. Austin, PhD ^c, Clare L. Atzema, MD, MSc ^a,^b,^c,^⁎
^a Division of Emergency Medicine, the Department of Medicine, University of Toronto, Toronto, Ontario, Canada
^b Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
^c Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

^∗Corresponding Author.

Abstract

Study objective

Patients treated primarily for hypertension are common in the emergency department (ED). The outcomes of these patients who were given a primary ED diagnosis of hypertension have not been described at a population level. In this study, we describe the characteristics and outcomes of these patients, as well as changes over time.

Methods

This retrospective cohort study used linked health databases from the province of Ontario, Canada, to assess ED visits made between April 1, 2002, and March 31, 2012, with a primary diagnosis of hypertension. We determined the annual number of visits, as well as the age- and sex-standardized rates. We examined visit disposition and assessed mortality outcomes and potential hypertensive complications at 7, 30, 90, and 365 days and at 2 years subsequent to the ED visit.

Results

There were 206,147 qualifying ED visits from 180 sites. Visits increased by 64% between 2002 and 2012, from 15,793 to 25,950 annual visits, respectively. The age- and sex-standardized rate increased from 170 per 100,000 persons to 228 per 100,000 persons during the same period, a 34% increase. Eight percent of visits ended in hospitalization, but this proportion decreased from 9.9% to 7.1% during the study period. Mortality was very low: less than 1% within 90 days, 2.5% within 1 year, and 4.1% within 2 years. Among subsequent hospitalizations for potential hypertensive complications, stroke was the most frequent admitting diagnosis, but the frequency was still less than 1% at 1 year. Together hospitalizations for stroke, heart failure, acute myocardial infarction, atrial fibrillation, renal failure, hypertensive encephalopathy, and dissection were less than 1% at 30 days.

Conclusion

The number of visits made primarily for hypertension has increased significantly during the last decade. Although some of the increase is due to aging of the population, other forces are contributing to it as well. Subsequent mortality and complication rates are low and have declined. With current practice patterns, the feared complications of hypertension are extremely infrequent.

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Plan

Introduction

Background

Importance

Goals of This Investigation

Materials and Methods

Study Design

Data Collection and Processing and Selection of Participants

Outcome Measures

Primary Data Analysis

Results

Limitations

Discussion

	Please see page 259 for the Editor’s Capsule Summary of this article.
	Supervising editor: Allan B. Wolfson, MD
	Author contributions: SM and CLA conceived and designed the study. PCA and CLA performed the analyses. SM drafted the article, and all authors contributed substantially to its revision. CLA takes responsibility for the paper as a whole.
	Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. Dr. Atzema is supported by a New Investigator Award from the Heart and Stroke Foundation of Ontario (HSFO), and Dr. Austin is supported by a Career Investigator Award from the HSFO. This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC).
	The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Canadian Institutes of Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed herein are those of the authors and not necessarily those of CIHI.
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