30-day Outcomes of Hypertensive Emergency Department Patients Discharged With Antihypertensive Therapy
Annals of Emergency Medicine
Study Objectives: Hypertension (HTN) is extremely common among emergency department patients (ED) and carries an elevated risk of stroke, myocardial infarction, aortic dissection, hypertensive encephalopathy, and death. Additionally, discharged ED patients with HTN have a high short-term revisit rate to the ED. It is currently unclear if prescribing antihypertensive therapy to discharged ED patients affects their short-term revisit rate or their short-term risk of severe adverse outcomes. We aimed to assess whether ED prescription of oral anti- hypertensive therapy on discharge for hypertensive patients decreases their 30- day risk of the severe adverse outcomes of aortic dissection, hypertensive encephalopathy, heart failure, myocardial infarction, stroke, and death as well as the 30-day risk of ED revisit. Methods: We conducted a retrospective observational study of discharged ED patients with HTN. The study was conducted at a health system in Michigan comprised of 8 hospitals, 7 of which are community EDs, one of which is a tertiary care center, with a combined 574,591 ED visits in 2019. We included all patients seen and discharged from any ED in the system over the age of 18 with an ED discharge diagnosis of HTN from the dates of January 1, 2016 to February 29, 2020. We excluded patients admitted to the hospital, admitted to an ED observation area, and pediatric patients. Data was collected for age, sex, race, maximum systolic and maximum diastolic blood pressure (BP) during ED visit, Charlson comorbidity index, antihypertensive treatment given in the ED, and discharge ED prescriptions. 30-day post discharge data was also collected for ED revisits, and for the following severe complications: aortic dissection, hypertensive encephalopathy, heart failure, myocardial infarction, stroke, and all-cause death. We assessed the effects of discharge ED antihypertensive prescriptions on ED return and a composite of severe adverse complications within 30 days using a multivariable logistic regression analysis, controlling for patient characteristics. Results: A total of 245,813 patients were included in our final analysis. 7185 (2.92%) received antihypertensive treatment on discharge. Patients receiving antihypertensive therapy were more likely to be younger, male, Black, to have higher BP, and lower comorbidity index. Prescription antihypertensive therapy was associated with a lower likelihood of severe outcomes (adjusted odds ratio [aOR], 0.69 [95% CI, 0.52 – 0.88], a lower likelihood of heart failure (aOR, 0.65 [95% CI, 0.46 – 0.88]), and a lower likelihood of 30-day ED return (aOR, 0.68 [95% CI, 0.64 – 0.73]. There were 55 cases of aortic dissection and 49 cases of hypertensive encephalopathy in the no-treatment group vs. zero and one respectively in the treatment group, although these findings were not statistically significant. Conclusion: Antihypertensive treatment for ED patients with HTN is associated with a decreased 30-day likelihood of a severe adverse outcomes and revisit to the ED
Todd B, Nguyen A, Chen NW, Eberhardt L, Bahl A. 40 30-day outcomes of hypertensive emergency department patients discharged with antihypertensive therapy. Annals of Emergency Medicine. 2022 Oct 1;80(4):S18-9.