Emergency department patients with acute severe hypertension: a comparison of those admitted versus discharged in studying the treatment of acute hypertension registry.

MedStar author(s):
Citation: Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine. 13(2):66-72, 2014 Jun.PMID: 24827883Institution: MedStar Washington Hospital CenterDepartment: Medicine/Pulmonary-Critical CareForm of publication: Journal ArticleMedline article type(s): Comparative Study | Journal Article | Multicenter Study | Observational Study | Research Support, Non-U.S. Gov'tSubject headings: *Antihypertensive Agents/tu [Therapeutic Use] | *Emergency Service, Hospital/sn [Statistics & Numerical Data] | *Hypertension/dt [Drug Therapy] | *Patient Admission/td [Trends] | *Patient Discharge/td [Trends] | *Registries | Acute Disease | Aged | Blood Pressure | Cross-Sectional Studies | Female | Follow-Up Studies | Humans | Hypertension/ep [Epidemiology] | Incidence | Male | Middle Aged | Patient Readmission/td [Trends] | Prognosis | Retrospective Studies | Severity of Illness Index | United States/ep [Epidemiology]Year: 2014Local holdings: Available online through MWHC library: March 2002 - presentISSN:
  • 1535-2811
Name of journal: Critical pathways in cardiologyAbstract: CONCLUSIONS: ED patients with severe hypertension were more likely to be admitted to the hospital if they were >75 years of age, presented with shortness of breath or altered mental status, or had a creatinine >1.5 mg/dL and were not on hemodialysis.METHODS: Studying the Treatment of Acute hyperTension (STAT) is a multicenter registry of 1566 patients with blood pressure >180/110 mm Hg who were treated with intravenous antihypertensive medications in an ED or intensive care unit. Presenting and in-hospital variables, and postdischarge outcomes for the 1053 patients in the ED subset were compared by disposition.OBJECTIVES: To compare the characteristics, treatments, and outcomes for emergency department (ED) patients with severe hypertension by disposition (admitted versus discharged home).RESULTS: In the multivariable analysis, ED patients were less likely to be discharged if >75 years of age (odds ratio [OR] = 0.3, 95% confidence interval [CI] = 0.1-0.9) or if they had shortness of breath (OR = 0.4, 95% CI = 0.2-0.8) or alteration of mental status (OR = 0.1, 95% CI = 0.02-0.9) on arrival. Nondialysis patients with an admission creatinine concentration >1.5 mg/dL were 80% less likely to be discharged than those <1.5 mg/dL (OR = 0.2, 95% CI = 0.08-0.5). In the bivariate analysis, patients with a decrease in systolic blood pressure of <10% 2 hours after medication administration were more likely to be admitted than those discharged (57% vs. 44%; P = 0.041). Disposition did not correlate with 90-day or 6-month mortality or 30-day readmission. However, admitted patients had a higher 90-day readmission rate (38% vs. 24%; P = 0.038).All authors: Amin A, Dasta JF, Froehlich JB, Kleinschmidt K, Levy P, Mayer SA, Multz AS, Peacock WF, Pollack C Jr, Shorr AF, STAT Investigators, Wyman AFiscal year: FY2014Digital Object Identifier: Date added to catalog: 2015-03-17
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 24827883 Available 24827883

Available online through MWHC library: March 2002 - present

CONCLUSIONS: ED patients with severe hypertension were more likely to be admitted to the hospital if they were >75 years of age, presented with shortness of breath or altered mental status, or had a creatinine >1.5 mg/dL and were not on hemodialysis.

METHODS: Studying the Treatment of Acute hyperTension (STAT) is a multicenter registry of 1566 patients with blood pressure >180/110 mm Hg who were treated with intravenous antihypertensive medications in an ED or intensive care unit. Presenting and in-hospital variables, and postdischarge outcomes for the 1053 patients in the ED subset were compared by disposition.

OBJECTIVES: To compare the characteristics, treatments, and outcomes for emergency department (ED) patients with severe hypertension by disposition (admitted versus discharged home).

RESULTS: In the multivariable analysis, ED patients were less likely to be discharged if >75 years of age (odds ratio [OR] = 0.3, 95% confidence interval [CI] = 0.1-0.9) or if they had shortness of breath (OR = 0.4, 95% CI = 0.2-0.8) or alteration of mental status (OR = 0.1, 95% CI = 0.02-0.9) on arrival. Nondialysis patients with an admission creatinine concentration >1.5 mg/dL were 80% less likely to be discharged than those <1.5 mg/dL (OR = 0.2, 95% CI = 0.08-0.5). In the bivariate analysis, patients with a decrease in systolic blood pressure of <10% 2 hours after medication administration were more likely to be admitted than those discharged (57% vs. 44%; P = 0.041). Disposition did not correlate with 90-day or 6-month mortality or 30-day readmission. However, admitted patients had a higher 90-day readmission rate (38% vs. 24%; P = 0.038).

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