About one-third of heart-related emergency department visits in the United States are for high blood pressure or related conditions, according to a study of more than 20 million emergency department visits between 2016 and 2018 .
13% of visits were for “essential” hypertension, which is high blood pressure not caused by other diseases.
The main diagnoses were different between men and women, and women were less likely than men to die or be admitted to hospital after a cardiovascular emergency.
The study authors suggest that their findings point to different cardiovascular health needs for men and women, especially those covered by Medicare and Medicaid.
(NewMediaWire) – September 20, 2022 – DALLAS Top cardiovascular (CVD) diagnoses in U.S. emergency departments suggest that many cardiovascular emergencies are due to poorly controlled high blood pressure, according to a study of more than 20 million emergency department visits published in September. 8 in the Journal of the American Heart Association, an open-access, peer-reviewed journal of the American Heart Association.
The researchers found that 13% of all heart-related emergency room diagnoses, representing more than 2.7 million people, were for “essential” hypertension, which is high blood pressure not caused by other diseases. Most cases of high blood pressure are essential hypertension.
“These visits resulted in hospital admission less than 3% of the time and with very few deaths, less than 0.1%. This suggests that these visits were primarily related to the management of hypertension,” said the lead author. Mamas A. Mamas, MD, a professor of cardiology at Keele University in Stoke-on-Trent and a consultant cardiologist at University Hospitals of North Midlands NHS Trust, both in the United Kingdom.
For the 15 CVD conditions detailed in the study, about 30% were hypertension-related diagnoses.
The study analyzed cardiovascular diagnoses made during emergency department visits that were part of the National Emergency Department sample from 2016 to 2018. The sample was 48.7% female, and the average of age was 67 years. Most were Medicare or Medicaid participants. Men in the sample were more likely to have other illnesses besides cardiovascular disease, such as diabetes, while women had higher rates of obesity, high blood pressure and medical conditions that affect the blood vessels in the brain.
The most common heart-related or stroke-related diagnoses for women seen in the emergency department were high blood pressure (16% of visits), heart or kidney disease related to high blood pressure (14.1%) and atrial fibrillation (10.2%). The most common diagnoses for men were heart or kidney disease related to high blood pressure (14.7%), high blood pressure (10.8%), and heart attack (10.7%).
“Previous studies have shown sex differences in CVD patterns among hospitalized patients,” Mamas said. “However, examining CVD encounters in the emergency department provides a more complete picture of the cardiovascular health care needs of men and women because it captures encounters before hospitalization.” He also notes that previous studies of CVD emergency visits are limited to visits for suspected heart attack. “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.”
The study found that the outcomes of CVD emergency visits were slightly different for men and women. Overall, women were less likely to die (3.3% of women vs. 4.3% of men) or be hospitalized (49.1% of women vs. 52.3% of men) after a visit to the emergency department 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.
“We didn’t track deaths outside the hospital setting,” Mamas said. “Given past evidence that women are more likely to be inappropriately discharged from the emergency department, and strong evidence of systemic undertreatment of women, further study is warranted to track the 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 blood work and other health information could have been obtained . In addition, the data are limited because they do not capture information related to disease severity, which can make comparisons about mortality differences between different patient groups difficult.
“Our work with this large, nationally representative sample of cardiovascular emergency visits highlights differences in the health care needs of men and women, which may be useful in informing service planning and delivery of health,” said Mamas. “We also encourage further research to understand the underlying factors that drive differences in CVD patterns and outcomes between men and women.”
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