Monitoring Global Risk of Cardiovascular Morbidity in an Emergency Department-Based Hypertension Registry

Abstract

Background Emergency Departments see a unique population of patients who, for a variety of reasons including socio-economic status and access to health care, may be at greater risk for cardiovascular morbidity than the general population. Data from the National Ambulatory Medical Care Survey demonstrates that Emergency Departments (ED) are being used increasingly as a primary source of health care for patients. Objective To assess the global risk of cardiovascular morbidity in patients seen in a busy community-based ED utilizing a newly established Hypertension Registry. Setting A university hospital with 65,000 annual emergency patient visits; 44 percent of patients are minorities. Methods All patients presenting to the emergency department age18 years or older are screened for hypertension in addition to race, sex, and history of cardiovascular disease. The charts of all patients with blood pressure over 130/85 mm Hg or a history of hypertension (including medications) are assessed for the concomitant presence of cardiovascular risk factors including diabetes, smoking, hypercholesterolemia, and prior complications of hypertension including stroke, congestive heart failure, and coronary artery disease. Home medications are recorded. ED course variables include cardiovascular medications given, subsequent blood pressures, diagnoses, admission status, discharge diagnosis and counseling. Results 3,923 patients were screened over 60 days. Twenty-nine percent gave a history of hypertension, and 37.4% had a blood pressure meeting at least stage 1 criteria (> 140/90 mm Hg). The majority of patients meeting Stage 1 criteria were unaware of their hypertension (52.7%). The table shows the increased frequency of both co-morbidities and prior complications of hypertension with advancing stages of hypertension in ED patients. The frequency of hypercholesterolemia did not vary with hypertension. Conclusions In this assessment of emergency department patients, global risk factors for cardiovascular morbidity increase with increasing stage of hypertension, and the frequency of known complications increase with the level of blood pressure. These risk factors are found in higher frequency than national averages. Reflecting the national changes in health care utilization, ED based hypertension registries may provide more timely and accurate information on cardiovascular risk and complications in community populations. Hypertension Stage Smoking Diabetes Mellitus Heart Failure (known) Stroke (known) Renal Disease (known) Stage 1 22.5% 14.1% 3.1% 2.6% 2.6% Stage 2 28.7% 18.4% 2.3% 4.6% 5.8% Stage 3 33.8% 24.6% 6.1% 9.2% 26.2%