Nearly a third of US heart-related emergency department visits are for high blood pressure or related conditions, according to a study of more than 20 million emergency department visits from 2016 – 2018.
13% of the visits were for “essential” hypertension, which is high blood pressure that is not caused by other diseases.
The top diagnoses differed between men and women, and women were less likely than men to die or be hospitalized after a cardiac emergency.
The study authors suggest that their findings point to different cardiovascular health needs for men and women, particularly those covered by Medicare and Medicaid.
,newmediawire) — September 20, 2022 — Dallas U.S. emergency departments’ top cardiovascular (CVD) diagnoses suggests that many cardiovascular emergencies are caused by poorly controlled high blood pressure, a study of more than 20 million emergency department visits published Sept. 8 suggests according to Journal of the American Heart AssociationAn open access, peer-reviewed journal of the American Heart Association.
The researchers found that 13% of all cardiac emergency department diagnoses, representing more than 2.7 million people, were for “essential” hypertension, which is high blood pressure that is not caused by other diseases. Most cases of high blood pressure are essential hypertension.
“These visits resulted in less than 3% of hospitalization time and very few deaths – less than 0.1%. This suggests that these visits were mostly related to the management of hypertension,” said lead author Mamas A. Mamas, MD, professor of cardiology at Kiel University in Stoke-on-Trent and a consultant cardiologist at University Hospitals of the North Midlands NHS Trust in the UK.
For the 15 CVD conditions detailed in the study, approximately 30% were diagnoses related to hypertension.
The study analyzed cardiovascular diagnoses made during emergency department visits that were part of a nationwide emergency department sample from 2016-2018. The sample was 48.7% women, and the mean age was 67 years. Most were Medicare or Medicaid participants. Men in the sample were more likely to have diseases other than heart disease, such as diabetes, while women had higher rates of obesity, high blood pressure and medical conditions affecting the blood vessels in the brain.
The most common heart- or stroke-related diagnoses for women seen in the emergency department were hypertension (16% of visits), high blood pressure-related heart or kidney disease (14.1%) and atrial fibrillation (10.2%). The most common diagnoses for men were high blood pressure-related heart or kidney disease (14.7%), hypertension (10.8%) and heart attack (10.7%).
“Previous studies have shown gender differences in the pattern of CVD among hospitalized patients,” Mamas said. “However, the investigation of CVD encounters in the emergency department provides a more complete picture of the cardiovascular health care needs of men and women, as it captures the encounters prior to hospitalization.” They also pointed out that previous studies of CVD emergency visits have been limited to suspected heart attack visits. “Therefore, this analysis of 15 CVD conditions helps to better understand the full spectrum of acute CVD needs, including the risk of hospitalization and death.”
The study found that the outcomes of emergency CVD visits were slightly different for men and women. Overall, women were less likely to die (3.3% of women vs. 4.3%) or to be hospitalized (49.1% of women vs. 52.3% of men) after an emergency department visit for CVD. This difference may be due to women’s generally low-risk diagnoses, Mamas said, but the deaths among women may be an underestimate.
“We did not track deaths outside the hospital setting,” Mamas said. “Given previous evidence that women are more likely to be inappropriately discharged from the emergency department, and strong evidence for systemic treatment of women, further studies are needed to track outcomes beyond the emergency department visit. “
An additional limitation of the data includes potential misdiagnosis errors in cases where the final diagnosis does not match the emergency diagnosis, particularly after hospitalization and additional bloodwork and other health information may be obtained. Furthermore, data is limited in that it does not capture information related to disease severity, which can make comparing mortality differences between different patient groups challenging.
“Our work with this large, nationally representative sample of cardiac emergency visits highlights differences in the health care needs of men and women, which may be useful for informing the planning and provision of health care services, Mamas said. “We encourage further research to understand the underlying factors that drive the differences in CVD patterns and outcomes between men and women.”
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