Hypertension-related Hospitalizations Research Articles

Area Deprivation and Postpartum Readmission Facility Location and Timing

This cohort study evaluates the role that community-level socioeconomic status plays in hypertension-related hospital readmission within 12 weeks after delivery.

Disease characteristics, treatments, and outcomes of patients with pulmonary arterial hypertension treated with selexipag in real-world settings from the SPHERE registry (SelexiPag: tHe usErs dRug rEgistry)

BackgroundSelexipag is an oral prostacyclin receptor agonist, indicated for pulmonary arterial hypertension to delay disease progression and reduce the risk of pulmonary arterial hypertension-related hospitalization. SelexiPag: tHe usErs dRug rEgistry (NCT03278002) was a US-based, prospective, real-world registry of selexipag-treated patients. MethodsAdults with pulmonary hypertension (enrolled 2016-2020) prescribed selexipag were followed for ≤18 months, with data collected at routine clinic visits. Patients were defined as newly or previously initiated if they had started selexipag ≤60 days or >60 days, respectively, before enrollment. ResultsThe registry included 829 patients (430 newly initiated, 399 previously initiated; 759 with pulmonary arterial hypertension), of whom 55.6% were World Health Organization functional class (FC) III/IV; 57.3% were intermediate or high risk per REVEAL 2.0. In patients with pulmonary arterial hypertension, 18-month discontinuation rates for adverse events were 22.0%, 32.0%, and 11.9%, and 18-month survival rates were 89.4%, 84.2%, and 94.5% in the overall, newly, and previously initiated patient populations, respectively. From baseline to Month 18, most patients had stable or improved FC and stable or improved REVEAL 2.0 risk category status. Discontinuation for adverse events, hospitalization, and survival were similar regardless of patients' individually tolerated selexipag maintenance dose. No new safety signals were identified. ConclusionsIn this real-world analysis of patients initiating selexipag, most patients had stable or improved FC and REVEAL 2.0 risk category. Similar to the GRIPHON trial, outcomes with selexipag in this real-world study were comparable across maintenance dose strata, with no new safety signals.

Out-of-Pocket Expenditure in Hypertension Related Care in India: Estimates from National Sample Survey 2017-18

Background: Studies estimating treatment cost associated with hypertension care in the Indian context are limited and show considerable variations. Objective: To estimate the extent of out-of-pocket expenditure (OOPE) for hypertension care at the population level and its financial impact on households in India. Methods: We analysed the data of the 75th round of the of NSSO survey (India) on the social consumption of health care conducted in 2017-18. OOPE was assessed after deducting the amount reimbursed by insurance from the total medical expenditure per episode of hypertension-related hospitalisation and outpatient visit during the survey period. OOPE for hypertension care was considered catastrophic if exceeding 10% of the household’s monthly per capita expenditure. The determinants of catastrophic health expenditures were examined using a multivariate logistic regression analysis. Results: A total of 1,351 and 6,379 individuals reported hypertension-related hospitalization and outpatient care, respectively, in the survey. The overall hypertension-related hospitalization rate was 54 per 100,000 persons. OOPE associated with hypertension-related hospitalisation were on an average INR 3,491 (SD 6,176) and INR 24,565 (SD 37,343) in public hospitals and private hospitals, respectively. The OOPE for hypertension related to outpatient visit was INR 277 (SD 571) in public facilities but was in the range of INR 457 (SD 556) – INR 695 (SD 1,431) based on the type of private hospitals/clinics. OOPE on medicines constituted on an average 43% (95% CI: 32-52%) and 66% (95% CI: 54-64%) of public sector hospitalisation and outpatient care respectively. The risk of catastrophic expenditure due to hypertension care was 41% among the poorest households. Conclusion: Direct expenses on drugs and diagnostic tests contribute significantly to OOPE. The on-going public health efforts towards controlling hypertension need to ensure better access to essential hypertensive drugs and diagnostic tests in public facilities.

Regional Health Disparities in Hypertension-Related Hospitalization of Hypertensive Patients: A Nationwide Population-Based Nested Case-Control Study.

Objective: This study aims to explore regional health disparities in hypertension-related hospitalizations and confirm this difference according to the states of continuity of care (COC). Methods: We used the National Health Insurance Service National Sample Cohort data from 2002 to 2019. The dependent variable, hypertension-related hospitalization, included hospitalization for hypertensive diseases (I10-I13, I15), ischemic heart disease (I20-I25), and cerebrovascular disease (I60-I69). Nested case-control matching was performed according to age, sex, and income level. We compared hypertension-related hospitalization fractions in urban and rural areas by classifying them according to the state of COC and analyzed them using conditional logistic regression suitable for matched data. Results: The odds of hypertension-related hospitalization of hypertensive patients were higher in the rural areas than in the urban areas; however, as the COC increased, the difference decreased. There was no change in the results according to the COC observation period. Conclusion: To reduce regional health disparities, both the promotion of COC and the improvement of the quality of primary care must be achieved.

Abstract 11728: Predictors of Secondary Pulmonary Hypertension-Related Hospitalizations and Subsequent Mortality in Adults With Obstructive Sleep Apnea

Background: Secondary pulmonary hypertension (SPH) is a predictor of poor outcomes in obstructive sleep apnea (OSA) patients. In this study, we examined sex/racial disparities, predictors and inpatient mortality in SPH-related hospitalizations among OSA patients. Methods: We used the National Inpatient Sample (2019) and ICD-10 codes to identify OSA-related hospitalizations with SPH. The burden of SPH and disparities by sex/race were assessed. We also compared the odds and predictors of in-hospital mortality in OSA patients with vs. without SPH. Results: Of total adult OSA hospitalizations (n=2317136, median age 66[56-74] years, males: 57.2%), 9.4% (218795/2317136) had SPH. Females vs Males (11.3% vs. 8.1%) and Blacks vs. other race groups (13.5%) with OSA had a higher prevalence of SPH [Fig. 1] . The SPH cohort often consisted of females (51 vs 41.9%), blacks (20.9 vs 14.0%), patients from lowest income quartile (29.7 vs 27.6%), Medicare insured (73.4 vs 60.6%), and non-elective admissions (89.2 vs 74.4%) vs. non-SPH cohort. SPH cohort also had a higher burden of complicated HTN (52.9 vs 36.3%), DM with complications (42.7 vs 32.4%), hyperlipidemia (59.4 vs 57.6%), COPD (52.5 vs 36.9%), history of prior MI (11.4 vs 9.6%) and venous thromboembolism (10.4 vs 8.4%). However, in-hospital mortality was more likely to be in males (OR 1.12 95%CI 1.00-1.25, p=0.048) vs Females, and OSA patients with metastatic cancer (OR 2.73 95%CI 2.04-3.65), solid non-metastatic tumors (OR 1.65 95%CI 1.26-2.15) (p<0.001). Our analysis also showed black ethnicity, hyperlipidemia, obesity, tobacco use, and history of venous thromboembolism and TIA were protective against inpatient mortality in SPH-OSA patients. Conclusions: The prevalence of SPH with OSA was greater in females and blacks, whereas males and whites had higher subsequent inpatient mortality. More prospective studies are needed to understand the role of co-morbidities on survival outcomes.

Abstract 15721: Gender Differences in Temporal Trends and Outcomes of Pulmonary Arterial Hypertension-Related Hospitalizations in the US

Introduction: There is limited data on the gender differences in the trend of hospitalizations related to PAH and associated outcomes in the US Methods: We queried the National Inpatient Sample from 2010 to 2019 to identify PAH admissions using international classification of diseases (ICD) codes 416.0 (ICD-9) and I27.0 (ICD-10) Results: 20,513 hospitalizations with PAH as the primary diagnosis was analyzed during the study period. There were 13,928 women (67.9%) and 6,584 (32.1%) men. The mean age among women (SD) and men (SD) were 66 years (16) and 65 years (17) respectively. Between 2010 and 2019, PAH hospitalization rates declined in both women (13.5% vs. 8.5%], P < 0.001) and men (14.2% vs. 8.3%, P = 0.027. The overall mortality rate was higher in men compared with women (6.6% vs. 5.7%, P = 0.015. Though crude mortality rates declined for the total population, this was statistically significant only among women (6.7% vs.5.6%, P = 0.011). On adjusted multivariate analysis, factors associated with increased odds of inpatient mortality among women were age 45 - 64 years (OR 1.62, 95% CI 1.11 - 2.37, P = 0.013) and > 65 years (OR 2.36, 95% CI 1.57 - 3.55, P<0.001) compared with age 18-44 years. Black (OR 1.44, 95% CI 1. 13 - 1.78, P < 0.001) and Hispanic race/ethnicity (OR 1.06, 95% CI 1.02 - 1.51, P = 0.037), compared with White race/ethnicity. Comorbidities and in-hospital complications associated with increased mortality were chronic kidney disease, acute pulmonary embolism (PE), and acute respiratory failure (ARF). Among men, age > 65 years (OR 3.28, 95% CI 1.68 - 6.41, P = 0.001), Black (OR 1.9, 95% CI 1.36 - 2.91, p < 0.001) and Hispanic race/ethnicity (OR 1.21, 95% CI 1.08 - 1.78, P = 0.021), compared with White race/ethnicity were associated with increased odds of mortality. The presence of congestive heart failure and complications of acute PE, ARF, acute ischemic stroke, and atrial fibrillation were also associated with increased mortality. Conclusions: From 2010 to 2019 in the US, PAH-related hospitalization rates decreased in both women and men while mortality only decreased among women. Men were more likely to die during hospitalization compared with women. Older age and Black and Hispanic race/ethnicity were associated with higher mortality in both women and men.

Abstract 288: Incidence And Outcomes Of In-hospital Cardiac Arrest Among Pulmonary Arterial Hypertension-related Hospitalizations In The United States

Background: Cardiac arrest is a known complication of Pulmonary arterial hypertension (PAH) often due to acute right heart failure and arrhythmias. However, data on trends in the incidence and in-hospital outcomes of in-hospital cardiac arrest (IHCA) among PAH-related hospitalizations in the US is limited. Hypothesis: IHCA incidence has declined and In-hospital outcomes improved among PAH-related hospitalizations. Methods: We identified hospitalizations with a primary diagnosis of PAH in the nationwide inpatient database between 2010 and 2019, using the appropriate international classification of disease codes. We extracted patients who underwent cardiopulmonary resuscitation for IHCA and evaluated temporal trends in the incidence and in-hospital outcomes using the Cochrane-Armitage test. Logistic regression was used to evaluate factors associated with odds of survival to hospital discharge. Results: We identified 18,772 PAH-related hospitalizations during the study period. The IHCA incidence rate was 1.8% with a mean age (SD) of 62 years (16) and females predominantly affected (62.8%). There was a non-significant decline in IHCA incidence rate between 2010 and 2019 (1.9% vs. 1.2%, P=0.08). The overall survival to hospital discharge rate was 30.4% and this increased significantly during the study period (26.7% vs 36.9%, P = 0.04). Most of the survivors were discharged to a long-term acute care facility (44.2%) and 18.% were discharged home without the need for home health care. Factors associated with lower odds of survival were age > 65 years OR 0.97, 95% CI 0.96 - 0.98, P < 0.001), acute right heart failure (OR 0.74, 95% CI 0.60 - 0.90, P<0.001), acute respiratory failure (OR 0.20, 95% CI 0.16 - 0.24, P < 0.001), and severe comorbidity index (OR 0.83, 95% CI 0.71-0.96, P < 0.001). The presence of shockable rhythm (OR 1.67, 95% CI 1.31 - 2.26, P=0.03) and obesity (OR 1.33, 95% CI 1.02 - 1.72, P=0.03) were associated with higher odds of survival Conclusion: Though IHCA survival among resuscitated PAH-related hospitalizations improved during the 10-year study period in the US, only about 3 out of 10 patients still survive to hospital discharge. Additional studies are warranted to identify strategies that will improve resuscitation outcomes in these patients.

Government-Expert Joint Intervention with Treatment Algorithm and Improved Hypertension Management and Reduced Stroke Mortality in a Primary-Care Setting.

Hypertension management is suboptimal in the primary-care setting of developing countries, where the burden of both hypertension and cardiovascular disease is huge. Therefore, we conducted a government-expert joint intervention in a resource-constrained primary setting of Emin, China, between 2014 and 2016, to improve hypertension management and reduce hypertension-related hospitalization and mortality. Primary-care providers were trained on treatment algorithm and physicians for specialized management. Public education was delivered by various ways including door-to-door screening. Program effectiveness was evaluated using screening data by comparing hypertension awareness, treatment, and control rates and by comparing hypertension-related hospitalization and total cardiovascular disease (CVD) and stroke mortality at each phase. As results, 313 primary-health providers were trained to use the algorithm and 3 physicians attended specialist training. 1/3 of locals (49490 of 133376) were screened. Compared to the early phase, hypertension awareness improved by 9.3% (58% vs. 64%), treatment by 11.4% (39% vs. 44%), and control rates by 33% (10% vs. 15%). The proportion of case/all-cause hospitalization was reduced by 35% (4.02% vs. 2.60%) for CVD and by 17% (3.72% vs. 3.10%) for stroke. The proportion of stroke/all-cause death was reduced by 46% (21.9% in 2011–2013 vs. 15.0% in 2014–2016). At the control area, the proportion of case/all-cause mortality showed no reduction. In conclusion, government-expert joint intervention with introducing treatment algorithm may improve hypertension control and decrease related hospitalization and stroke mortality in underresourced settings.

Abstract P178: Social Determinants Of Health And Preventable Hospitalization For Hypertension

Introduction: Social determinants of health (SDH) can have a significant impact on the risk of hypertension related hospitalization. Understanding the drivers of potentially preventable hospitalizations for hypertension improves health outcomes and reduce associated costs. Identifying place and associated SDH has implications for tailored interventions to address disparities for high burden population for preventable hypertension hospitalization as hypertension and associated cardiovascular disease. Methods: County level preventable hospitalization rates for hypertension for Virginia was obtained using prevention quality indicators published by the Agency for Healthcare Research and Quality. The Health Opportunity Index (HOI), developed by the Virginia Department of Health to identify vulnerable populations is a multivariate tool that uses complex SDH indicators of a community and comprises of 13 indices - affordability, income inequality, Townsend/Material deprivation, job participation, employment access, education, air quality, segregation, food accessibility, population density, population churning, walkability, and access to care. Principal component analysis was used to develop the composite HOI and further aggregated into simple quintiles at the county level. Step-wise multiple regression analysis was performed to explore SDH and preventable hospitalization for hypertension. Results: Material deprivation index ( r = -.44), affordability index ( r = -.42) and air quality index ( r = -.23) were found to be significantly associated with preventable hospitalization rate for hypertension. Together the model accounted for 23% of the variability in the preventable hypertension hospitalization rate ( p > 0.05). Conclusions: Findings indicate that neighborhoods that spend most on housing and transportation and that are materially deprived of goods, services, amenities and resources and physical environment have higher rates of preventable hospitalization for hypertension. Areas with higher air pollution may result in hypertension. Addressing these disparities by targeted approach is one possible approach to reducing the burden of preventable hospitalization for hypertension in Virginia.

Risk factors for 30-day readmission in adults hospitalized for pulmonary hypertension.

Readmissions for pulmonary hypertension are poorly understood and understudied. We sought to determine national estimates and risk factors for 30-day readmission after pulmonary hypertension-related hospitalizations. We utilized the Healthcare Cost and Utilization Project Nationwide Readmission Database, which has weighted estimates of roughly 35 million discharges in the US. Adult patients with primary International Classification of Disease, Ninth Revision, Clinical Modification diagnosis codes of 416.0 and 416.8 for primary and secondary pulmonary hypertension with an index admission between 2012 and 2014 and any readmission within 30 days of the index event were identified. Predictors of 30-day readmission were identified using multivariable logistic regression with adjustment for covariates. Results showed that the national estimate for Primary Pulmonary Hypertension vs Secondary Pulmonary Hypertension-related index events between 2012 and 2014 with 30-day readmission was 247 vs 2550 corresponding to a national readmission risk estimate of 17% vs 18.3%, respectively. The presence of fluid and electrolyte disorders, renal failure, and alcohol abuse were associated with increased risk of readmission in Primary Pulmonary Hypertension, while factors associated with Secondary Pulmonary Hypertension readmissions included anemia, congestive heart failure, lung disease, fluid and electrolyte disorders, renal failure, diabetes, and liver disease. The median cost of Primary Pulmonary Hypertension admissions and readmissions were $46,132 (IQR: $25,384–$85,647) and $41,604.50 (IQR: $22,481.50–$84,420.50), respectively. The median costs of Secondary Pulmonary Hypertension admissions and readmissions were $34,893 (IQR: $19,670–$66,143) and $36,279 (IQR: $19,059–$74,679), respectively. In conclusion, approximately 19% of Primary Pulmonary Hypertension and Secondary Pulmonary Hypertension hospitalizations result in 30-day readmission, with significant costs accrued during the index hospitalization and readmission. With evolving clinical terminology and diagnostic codes, future study will need to better clarify underlying factors associated with readmissions amongst pulmonary hypertension sub-types, and identify methods and procedures to minimize readmission risk.

Comparative effectiveness of oral prostacyclin pathway drugs on hospitalization in patients with pulmonary hypertension in the United States: a retrospective database analysis.

Two oral medications targeting the prostacyclin pathway are available to treat pulmonary arterial hypertension in the United States: oral treprostinil and selexipag. We compared real-world hospitalization in patients receiving these medications. A retrospective administrative claims study was conducted using the Optum® Clinformatics® Data Mart database. Patients with pulmonary hypertension were identified using diagnostic codes. Cohort inclusion required age ≥ 18 years, first oral treprostinil or selexipag prescription between 1 January 2015 and 30 September 2017 (index date), and continuous enrollment in the prior ≥6 months. Patients who switched index drug were excluded. Follow-up was from index date until the first of end of index drug exposure, end of continuous enrollment, death, or 31 December 2017. Multivariable Cox proportional hazard and Poisson regression were used to compare risk and rate, respectively, of hospitalization associated with oral treprostinil vs. selexipag, adjusting for potential confounders. The study cohort included 99 patients receiving oral treprostinil and 123 receiving selexipag. Mean age was 61 years, and most patients were females (71%). Compared with oral treprostinil, selexipag was associated with a 46% lower risk of all-cause hospitalization (hazard ratio 0.54, 95% confidence interval 0.31, 0.92; P = 0.02), a 47% lower risk of pulmonary hypertension-related hospitalization (hazard ratio 0.53, 95% confidence interval 0.31, 0.93; P = 0.03), a 42% lower all-cause hospitalization rate (rate ratio 0.58, 95% confidence interval 0.39, 0.87; P = 0.01), and a 46% lower pulmonary hypertension-related hospitalization rate (rate ratio 0.54, 95% confidence interval 0.35, 0.82; P = 0.004). This study suggests that selexipag is associated with lower hospitalization risk and rate than oral treprostinil.

Baroreflex activation therapy reduces frequency and duration of hypertension-related hospitalizations in patients with resistant hypertension

PurposeBaroreflex activation therapy (BAT) has been shown to lower blood pressure in patients with resistant hypertension. The purpose of this study was to analyze whether this translates into a reduction of more relevant clinical endpoints.MethodsPatients with resistant hypertension were treated with the second-generation BAT system. Records on hospitalization (dates of admission and discharge, main diagnosis) were obtained from medical insurance companies.ResultsRecords on hospitalization were available for a period of 1 year before BAT in two patients and 2 years in 22 patients. The total number of hospitalizations per patient was 3.3 ± 3.5/year before BAT and 2.2 ± 2.7/year after BAT (p = 0.03). Hospitalizations related to hypertension were significantly decreased from 1.5 ± 1.6/year before BAT to 0.5 ± 0.9/year after BAT (p < 0.01). The cumulative duration of hypertension-related hospital stays was significantly reduced from 8.0 ± 8.7 days/year before BAT to 1.8 ± 4.8 days/year after BAT (p < 0.01). Office cuff blood pressure was 183 ± 27 mmHg over 102 ± 17 mmHg under 6.6 ± 2.0 antihypertensive drugs before BAT and 157 ± 32 mmHg over 91 ± 20 mmHg (both p < 0.01) under 5.9 ± 1.9 antihypertensive drugs (p = 0.09 for number of drugs) at latest follow-up. Daytime ambulatory blood pressure was 164 ± 21 mmHg over 91 ± 14 mmHg before BAT and 153 ± 21 mmHg (p = 0.03) over 89 ± 15 mmHg (p = 0.56) at latest follow-up. Heart rate was 75 ± 16 bpm before BAT and 72 ± 12 bpm at latest follow-up (p = 0.35).ConclusionsRate and duration of hypertension-related hospitalizations in patients with severe resistant hypertension were lowered after BAT. Whether the response is mediated through improvements in blood pressure control requires further studies.

Protocol for the evaluation of a pilot implementation of essential interventions for the prevention of cardiovascular diseases in primary healthcare in the Republic of Moldova

IntroductionNearly 90% of all deaths in the Republic of Moldova are caused by non-communicable diseases, the majority of which (55%) are caused by cardiovascular diseases (CVD). In addition to reducing...

Temporal Trends in Cardiovascular Hospital Discharges Following a Mass Chlorine Exposure Event in Graniteville, South Carolina.

Background: On January 6, 2005, a train derailed in Graniteville, South Carolina, releasing nearly 60,000 kg of toxic chlorine gas. The disaster left nine people dead and was responsible for hundreds of hospitalizations and outpatient visits in the subsequent weeks. While chlorine gas primarily affects the respiratory tract, a growing body of evidence suggests that acute exposure may also cause vascular injury and cardiac toxicity. Here, we describe the incidence of cardiovascular hospitalizations among residents of the zip codes most affected by the chlorine gas plume, and compare the incidence of cardiovascular discharges in the years leading up to the event (2000–2004) to the incidence in the years following the event (2005–2014).Methods: De-identified hospital discharge information was collected from the South Carolina Revenue and Fiscal Affairs Office for individuals residing in the selected zip codes for the years 2000 to 2014. A quasi-experimental study design was utilized with a population-level interrupted time series model to examine hospital discharge rates for Graniteville-area residents for three cardiovascular diagnoses: hypertension (HTN), acute myocardial infarction (AMI), and coronary heart disease (CHD). We used linear regression with autoregressive error correction to compare slopes for pre- and post-spill time periods. Data from the 2000 and 2010 censuses were used to calculate rates and to provide information on potential demographic shifts over the course of the study.Results: A significant increase in hypertension-related hospital discharge rates was observed for the years following the Graniteville chlorine spill (slope 8.2, p < 0.001). Concurrent changes to CHD and AMI hospital discharge rates were in the opposite direction (slopes −3.2 and −0.3, p < 0.01 and 0.14, respectively). Importantly, the observed trend cannot be attributed to an aging population.Conclusions: An unusual increase in hypertension-related hospital discharge rates in the area affected by the Graniteville chlorine spill contrasts with national and state-level trends. A number of factors related to the spill may be contributing the observation: disaster-induced hypertension, healthcare services access issues, and, possibly, chlorine-induced susceptibility to vascular pathologies. Due to the limitations of our data, we cannot determine whether the individuals who visited the hospital were the ones exposed to chlorine gas, however, the finding warrants additional research. Future studies are needed to determine the etiology of the increase and whether individuals exposed to chlorine are at a heightened risk for hypertensive heart disease.

Abstract P210: Blood Pressure Medication Adherence Among Medicare Beneficiaries, Causes and Consequences

Introduction: Medication non-adherence is a major healthcare barrier, especially among diseases which are largely asymptomatic such as hypertension. The impact of poor medication adherence ranges from patient specific adverse health outcomes to broader strains on health care system resources. Accordingly, there is rich literature examining the causes and consequences of suboptimal medication adherence. Objective: To document the relationship between blood pressure medication adherence, socioeconomic status, health care costs, and outcomes among Medicare beneficiaries with heart disease in the United States. Methods: The CDC Wonder database was used to retrieve Centers for Medicare and Medicaid Services’ data pertaining to blood pressure medication adherence, socio-economic variables, per-capita healthcare costs, and cardiovascular outcomes among beneficiaries by county across the United States. Spearman correlation was used to analyze the relationship between various factors. Results: Among Medicare beneficiaries, blood pressure medication non-adherence rates ranged from 15.9% to 56.2% with a mean of 26.5% ± 5.3% among the 3,196 counties reporting data. Factors that strongly correlated with non-adherence include poor educational attainment (0.678, p&amp;lt0.01) and poverty status (0.613, p&amp;lt0.01). Although non-adherence had a weakly positive relationship with inpatient costs (0.183, p&amp;lt0.01) and total overall costs (0.324, p&amp;lt0.01), it demonstrated a solid correlation with cardiovascular deaths (0.42, p&amp;lt0.01), stroke death (0.420, p&amp;lt0.01), stroke hospitalization (0.415, p&amp;lt0.01), and hypertension related hospitalization (0.561, p&amp;lt0.01). Conclusions: Our analysis of Medicare beneficiary data across the United States demonstrates a strong correlation between socioeconomic determinants of health and poor medication adherence. Our data further demonstrates that poor medication adherence translates into both worse cardiovascular outcomes and higher health care costs. In an era where health care spending has become overwhelmingly problematic, these findings provide compelling evidence for increased efforts focusing on educational and incentive based programs to improve medication adherence.

Fine particulate air pollution associated with increased risk of hospital admissions for hypertension in a tropical city, Kaohsiung, Taiwan

ABSTRACTThe aim of this study was to assess whether a correlation exists between fine particles (PM2.5) levels and number of hospital admissions for hypertension in Kaohsiung, Taiwan. Hospital admission frequency and ambient air pollution data were obtained for Kaohsiung for 2009–2013. A time-stratified case-crossover method was used to estimate relative risk for hospital admissions, controlling for weather, day of the week, seasonality, and long-term time trends. Odds ratios and 95% confidence intervals were calculated for a 10 µg/m3 increment of PM2.5 for lags from days 0 to 6. Data showed no significant associations between PM2.5 levels and number of hypertension-related hospital admissions on warm days (>25°C). However, on cool days (<25°C), a significant positive association was found with frequency of hypertension admissions in the single-pollutant model (without adjusting for other pollutants) with a 10 µg/m3 rise in PM2.5 on day of admission (lag 0) associated with a 12% increase in number of admissions for hypertension. In the two-pollutant model, the association of PM2.5 with rate of hypertension hospitalizations remained significant after including SO2 or O3 on lag day 0. Data demonstrate that an association between short-term exposure to PM2.5 and elevated risk of hypertension-related hospital admissions may exist in Kaohsiung, Taiwan, a tropical city.

Abstract P008: Have Trends in Preventable Hospitalizations Related to Hypertension Decreased Among Elderly Americans? Results From National Inpatient Sample, 2005-2014

Introduction: As number of elderly Americans is projected to double by 2050, population aged ≥65 years will have the highest impact on Medicare spending. The prevalence of elderly population with hypertension (HTN) is around 65% and if patients receive good primary care or an early intervention, these HTN related hospitalizations could be prevented saving millions in Medicare spending. Our objective was to examine the trends in hospitalizations related to HTN and total cost over 10 years among aged ≥65 years. Methods: Using data from Nationwide Inpatient Sample database from 2005-2014, we explored the existence of trends in HTN admission rates and corresponding hospitalization costs among adults ≥65 years vs other age groups. Weighted estimates for rates and mean total cost were reported using SUDAAN after adjusting for complex survey design. Results: Overall, hospitalizations due to HTN increased by 26% in 2014 from 2005. Hospitalizations were highest among patients ≥65 years (57.8%) followed by 40-64 (32.6%) and 18-39 years (9.6%). During 2005-2014, hospitalization rates among ≥65 years increased significantly (10.7%, p &lt;0.001), where as a decreasing trend was observed in other age groups. The total cost of hospitalization significantly increased from $302M in 2005 to $472M in 2014 among ≥65 years ( p &lt;0.001). In general, highest change in total cost was observed among Medicare patients where it increased by 53% to $145 million in 2014 compared to 2005. Conclusion: Hospitalizations and costs associated with HTN, especially Medicare, have increased over the past 10 years among elderly. Although these trends are alarming, these events could be prevented through symptom management at primary care, medication adherence, care coordination, or modifying care-seeking behavior resulting in potential savings of 851M over a year. This would reduce burden of Medicare spending, which is projected to surpass the rate of growth in federal revenues.

30-Day Readmissions After Pulmonary Artery Hypertension-Related Hospitalizations: Measures and Predictors

30-Day Readmissions After Pulmonary Artery Hypertension-Related Hospitalizations: Measures and Predictors

PP.15.37] REDUCED RATE AND DURATION OF HYPERTENSION-RELATED HOSPITALIZATION AFTER TREATMENT WITH BAROREFLEX ACTIVATION THERAPY

Objective: Baroreflex activation therapy (BAT) has been shown to lower blood pressure in patients with resistant hypertension. It is not known, however, whether this translates into a reduction of relevant clinical endpoints. Therefore, we investigated hospitalization rates before and after initiation of BAT. Design and method: After patients‘ written informed consent, records on hospitalization (dates of admission and discharge, main diagnosis) were obtained from medical insurance companies of 24 patients treated with the 2nd generation BAT system. Hospitalization data were annualized to account for variable periods of follow-up. Initial eligibility criteria for BAT were systolic office cuff blood pressure above 140 mmHg despite treatment with at least 3 antihypertensive drugs including at least one diuretic, and exclusion of secondary hypertension. Office cuff blood pressure was measured in sitting position with an automated system, which calculated the mean of 5 recordings at 2 min intervals. Data were tested for statistical significance by Wilcoxon test and are presented as mean ± standard deviation. Results: Records on hospitalization were available for a period of 1 year before BAT activation in 2 patients and 2 years before BAT activation in 22 patients. Follow-up after BAT activation was 1259 ± 498 days. The total number of hospitalizations was 3.3 ± 3.5 per year before BAT and 2.2 ± 2.7 per year after BAT (p = 0.03). Hospitalizations related to hypertension were significantly decreased from 1.5 ± 1.7 per year before BAT to 0.5 ± 0.9 per year after BAT (p < 0.01); scheduled hospitalization for BAT implantation was not counted. The cumulative duration of hypertension-related hospital stays was significantly reduced from 8.3 ± 9.1 days per year before BAT to 1.8 ± 4.8 days per year after BAT (p < 0.01). Office cuff blood pressure was 177 ± 26 over 99 ± 17 mmHg before BAT and 154 ± 32 over 90 ± 17 mmHg at latest follow-up (p < 0.01 for systolic and diastolic blood pressure). Conclusions: Besides the known reduction in blood pressure, BAT lowered the rate of hospitalizations related to hypertension in patients with severe resistant hypertension, suggesting that the positive effect of BAT on blood pressure may translate into a reduction of relevant clinical endpoints.

Effects of integrated chronic care models on hypertension outcomes and spending: a multi-town clustered randomized trial in China

BackgroundHypertension affects one billion people globally and is one of the leading risk factors for cardiovascular and renal diseases. However, hypertension management remains poor, especially in rural China.MethodsA clustered randomized controlled trial was conducted in six towns in China’s Qianjiang county between 7/2012 and 6/2014, including 5462 hypertension patients above 35 years old. Six towns were randomly assigned to three groups: Group 1 had the integrated care model including a multidisciplinary team and continuous care coordination, Group 2 had both the integrated care model and provider-level financial incentives, and the control group had the usual care. Primary outcomes were systolic blood pressure and health-related quality of life measured by SF36; secondary outcomes included hypertension-related hospitalization rate and inpatient spending. Blood pressure was measured sixteen times bimonthly between 12/1/2011 and 6/30/2014, and quality of life was measured on 7/1/2012 and 6/30/2014. Inpatient data between 7/1/2010 and 8/31/2014 were used. This trial is registered at the World Health Organization’s International Clinical Trials Registry, number ChiCTR-OOR-14005563.ResultsWe found that the integrated care model effectively lowered blood pressure by 1.93 mmHg (95% CI 0.063–3.8), improved self-assessed health-related quality of life, and reduced the rate of hypertension-related hospitalization by 0.17 percentage points (95% CI 0.094–0.24). We also found that the provider-level financial contract further lowered blood pressure by 1.76 mmHg (95% CI 0.73–2.79) and reduced rates of hospitalization and inpatient spending, but it also reduced patients’ self-assessed health-related quality of life.ConclusionsIntegrated care and financial incentives are effective in lowering blood pressure and reducing hospitalization rate, but financial contracts may hurt patient quality of life.This trial was registered at the Chinese Clinical Trial Registry (ChiCTR-OOR-14005563) on November 23, 2014. It was a retrospective registration.