The burden of hypertension in the emergency department and linkage to care: A prospective cohort study in Tanzania.

Sophie W Galson,Gloria Temu,Catherine A Staton,Nathan Thielman,John W Stanifer,Julian T Hertz,Temitope Gafaar,Sonak D Pastakia

doi:10.1371/journal.pone.0211287

Abstract

ObjectivesGlobally, hypertension affects one billion people and disproportionately burdens low-and middle-income countries. Despite the high disease burden in sub-Saharan Africa, optimal care models for diagnosing and treating hypertension have not been established. Emergency departments (EDs) are frequently the first biomedical healthcare contact for many people in the region. ED encounters may offer a unique opportunity for identifying high risk patients and linking them to care.MethodsBetween July 2017 and March 2018, we conducted a prospective cohort study among patients presenting to a tertiary care ED in northern Tanzania. We recruited adult patients with a triage blood pressure ≥ 140/90 mmHg in order to screen for hypertension. We explored knowledge, attitudes and practices for hypertension using a questionnaire, and assessed factors associated with successful follow-up. Hypertension was defined as a single blood pressure measurement ≥ 160/100 mmHg or a three-time average of ≥ 140/90 mmHg. Uncontrolled hypertension was defined as a three-time average measurement of ≥ 160/100 mmHg. Successful follow-up was defined as seeing an outpatient provider within one month of the ED visit.ResultsWe enrolled 598 adults (mean age 59.6 years), of whom 539 (90.1%) completed the study. The majority (78.6%) of participants were aware of having hypertension. Many (223; 37.2%) had uncontrolled hypertension. Overall, only 236 (43.8%) of participants successfully followed-up within one month. Successful follow-up was associated with a greater understanding that hypertension requires lifelong treatment (RR 1.11; 95% CI 1.03,1.21) and inversely associated with greater anxiety about the future (RR 0.80; 95% CI 0.64,0.99).ConclusionIn a northern Tanzanian tertiary care ED, the burden of hypertension is high, with few patients receiving optimal outpatient care follow-up. Multi-disciplinary strategies are needed to improve linkage to care for high-risk patients from ED settings.

Highlights

Cardiovascular disease is the leading cause of global morbidity and mortality [1, 2]
Only 236 (43.8%) of participants successfully followed-up within one month
Multi-disciplinary strategies are needed to improve linkage to care for high-risk patients from Emergency departments (EDs) settings

Summary

Introduction

Cardiovascular disease is the leading cause of global morbidity and mortality [1, 2]. Sub-Saharan Africa (SSA) is vulnerable to the growing global burden of cardiovascular disease, which disportionately impacts low-and-middle income countries (LMICs)[3]. Over the past few decades, in an effort to build a sustainable health financing structure for non-communicable diseases such as hypertension, many SSA countries have made crucial changes to expand health insurance coverage and promote outpatient care [9]. Community Health Fund (CHF) and Tiba Kwa Kadi (TIKA) are other publicly-owned insurance strategies; they target the informal sector and are managed at district and municipal levels respectively [11]. A recent study assessed the preparedness of 725 health facilities and found that only 28% were prepared for outpatient screening or primary care management of hypertension and many of these facilities lacked basic equipment such as blood pressure cuffs or treatment guidelines [13]

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