Demographics and Outcomes of Pulmonary Hypertension Patients in United States Emergency Departments.

Susan Wilcox,M Kamal Faridi,Carlos Camargo Jr

doi:10.5811/westjem.2020.2.45187

Susan Wilcox, M Kamal Faridi + Show 1 more

Open Access

https://doi.org/10.5811/westjem.2020.2.45187

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Abstract

IntroductionPulmonary hypertension (PH) is a common, yet under-diagnosed, contributor to morbidity and mortality. Our objective was to characterize the prevalence of PH among adult patients presenting to United States (US) emergency departments (ED) and to identify demographic patterns and outcomes of PH patients in the ED.MethodsWe analyzed the Nationwide Emergency Department Sample (NEDS) database, with a focus on ED patients aged 18 years and older, with any International Classification of Diseases, Clinical Modification (ICD)-9-CM or ICD-10-CM diagnosis code for PH from 2011 to 2015. The primary outcome was inpatient, all-cause mortality. The secondary outcomes were hospital admission rates and hospital length of stay (LOS).ResultsFrom 2011 to 2015, in a sample of 121,503,743 ED visits, representing a weighted estimate of 545,500,486 US ED visits, patients with a diagnosis of PH accounted for 0.78% (95% confidence interval [CI], 0.75–0.80%) of all US ED visits. Of the PH visits, 86.9% were admitted to the hospital, compared to 16.3% for all other ED visits (P <0.001). Likewise, hospital LOS and hospital-based mortality were higher in the PH group than for other ED patients (e.g., inpatient mortality 4.5% vs 2.6%, P < 0.001) with an adjusted odds ratio (aOR) of 1.34 (95% CI, 1.31–1.37). Age had the strongest association with mortality, with an aOR of 10.6 for PH patients over 80 years (95% CI, 10.06–11.22), compared to a reference of ages 18 to 30 years.ConclusionIn this nationally representative sample, presentations by patients with PH were relatively common, accounting for nearly 0.8% of US ED visits. Patients with PH were significantly more likely to be admitted to the hospital than all other patients, had longer hospital LOS, and increased risk of inpatient mortality.

Highlights

Pulmonary hypertension (PH) is a common, yet under-diagnosed, contributor to morbidity and mortality
Hospital length of stay (LOS) and hospital-based mortality were higher in the PH group than for other emergency departments (ED) patients with an adjusted odds ratio of 1.34
From 2011 to 2015, there was a weighted estimate of 4,233,762 United States (US) ED visits, with an annual average of 846,752 visits among adults with PH, which accounted for 0.78% (95% confidence interval [confidence intervals (CI)], 0.75-0.80%) of all US ED visits for adults

Summary

Introduction

Pulmonary hypertension (PH) is a common, yet under-diagnosed, contributor to morbidity and mortality. Pulmonary hypertension (PH) is defined as pressure elevation in the pulmonary circulation with a mean pulmonary artery pressure over 25 millimeters of mercury (mmHg)[1] and can arise from a multitude of physiologic insults resulting in increased pulmonary vascular resistance This sustained elevation in pressure leads to strain on the right ventricle[2] and eventual heart failure if untreated.[3] In addition to resulting in chronic issues, PH impacts the approach to resuscitation, as common interventions such as volume administration or intubation can be deleterious in the setting of right heart failure.[2,4] Despite having substantial clinical impact, PH remains under-diagnosed.[5] Over the last 30 years, clinicians outside the emergency department (ED) have increasingly recognized the risks of PH and right ventricular failure,[2,6] but this diagnosis has been underappreciated during emergency care.[4,7,8] Quantifying the burden of PH in the ED is difficult, as it is a heterogeneous condition, with five groups defined by the World Health Organization based upon the underlying etiology.[9] Data are sparse for the rates of patients with PH presenting to EDs, and Demographics and Outcomes of PH Patients in US EDs there are no studies of the diagnosis or management of PH in the ED. The remaining literature on the assessment of PH in the ED is limited to case reports[13,14] and a small observational study.[15]

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