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ED visits for hypertension, many unnecessary, increasing
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Increased home monitoring of BP may be leading to unnecessary ED visits, according to study data published in Annals of Emergency Medicine.
“We encourage patients to monitor their [BP] at home ... but not every high [BP] reading is an emergency,” Clare Atzema, MD, an emergency physician at Sunnybrook Health Sciences Centre and a scientist at the Institute for Clinical Evaluative Sciences, Toronto, said in a press release. “We suspect that recent public education campaigns ... may have inadvertently contributed to the rise in [ED] visits for hypertension.”
Clare Atzema
Researchers analyzed data from 206,147 ED visits by patients with a primary diagnosis of hypertension (median age, 64 years) in Ontario, Canada, from 2002 to 2012. Most patients (81.4%) had a history of hypertension. Some patients had diabetes (20.9%), chronic obstructive pulmonary disease (16.5%), HF (7.4%), previous acute MI (4.6%) and stroke (2.6%).
The researchers wrote, “Hypertension awareness may have increased substantially in the last decade because ... in 2005, the Canadian Hypertension Education Program began recommending home [BP] monitoring as a self-management tool. ... U.S. and European guidelines have done the same.”
During the study period, ED visits for hypertension increased from 15,793 per year to 25,950 per year, a 64.3% rise (average annual increase, 6.2%; 95% CI, 5.5-7), but hospital admissions decreased from 9.9% to 7.1%, a 28% relative reduction, according to the researchers. Among those whose ED visit resulted in admission, the most frequent causes were stroke (5.3%), renal failure (5.2%) and HF (3.1%).
Mortality rates were 0.17% at 7 days, 0.43% at 30 days, 0.85% at 90 days, 2.5% at 1 year at 4.4% at 2 years, with all mortality outcomes declining during the study period (P < .001), Atzema and colleagues wrote.
The researchers wrote that a limitation of the study is that most ED patients with incidental findings of hypertension do not show the same diagnosis at follow-up and tend to be younger than those with a correct hypertension diagnosis, both of which are likely indicators of better outcomes than those experienced by patients in the cohort.
“Stroke remains a huge killer and we do appreciate patients with hypertension being so conscientious about monitoring their readings,” Atzema said in the release. “Patients should be aware that unless their high [BP] coincides with symptoms of a medical emergency, such as chest pain, severe headache, nausea or shortness of breath, they probably do not need to visit the [ED].” – by James Clark
Disclosure: The researchers report no relevant financial disclosures.
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