Advertisement

Hypertensive ED patients: Missed opportunities for addressing hypertension and facilitating outpatient follow-up

Published:October 04, 2018DOI:https://doi.org/10.1016/j.ajem.2018.09.030

      Abstract

      Objectives

      Hypertension is a leading cause of morbidity and mortality. The emergency department (ED) frequently serves populations with unmet health needs and could have a greater and more systematic role in secondary prevention for hypertension. This study sought to determine, among hypertensive patients discharged from the ED, the frequency that patients 1) received hypertension-specific education, and 2) followed-up with a primary care provider. We secondarily assessed participant beliefs about hypertension.

      Methods

      This non-experimental, observational study enrolled a convenience sample of consenting patients with asymptomatic, markedly elevated blood pressure (systolic ≥160 mmHg or diastolic ≥100 mmHg) with medium to low triage acuity discharged from an urban, academic ED. Discharge instructions were assessed through chart review. Patients followed up per their normal routine without intervention. Participants were interviewed by phone two to four weeks after ED discharge to ascertain outpatient follow-up and describe beliefs about hypertension.

      Results

      From April through June 2014, 200 patients were approached, of whom 90 were enrolled. Of these, 77% of patients reported a previous diagnosis of hypertension, and 60% reported current treatment with antihypertensive medications. Five patients (5.5%) received written instructions at discharge addressing hypertension, although 59 (65.6%) reported that they were informed about their elevated blood pressure during the ED visit. Follow-up with a primary care provider within 2–4 weeks of discharge was completed in 57% of cases. None of the patients who received hypertension-specific discharge instructions completed follow-up.

      Conclusions

      Over half of markedly hypertensive patients discharged from the ED followed up with primary care within four weeks. Nonetheless, missed opportunities for improved secondary prevention among ED patients with hypertension are common. There is an urgent need for evidence-based interventions to assist emergency departments in addressing this health threat.

      Keywords

      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Whelton P.K.
        • Carey R.M.
        • Aronow W.S.
        • et al.
        ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines.
        J Am Coll Cardiol. 2017; 2017
        • Ornstein S.M.
        • Nietert P.J.
        • Jenkins R.G.
        • Litvin C.B.
        The prevalence of chronic diseases and multimorbidity in primary care practice: a PPRNet report.
        J Am Board Fam Med. 2013; 26: 518-524
        • Levy P.D.
        • Cline D.
        Asymptomatic hypertension in the emergency department: a matter of critical public health importance.
        Acad Emerg Med. 2009; 16: 1251-1257
        • He F.J.
        • MacGregor G.A.
        Cost of poor blood pressure control in the UK: 62,000 unnecessary deaths per year.
        J Hum Hypertens. 2003; 17: 455-457
        • Johnson T.
        • Patel R.
        • Scott N.
        • et al.
        Access to disease treatment among patients presenting to the emergency department with asthma or hypertension.
        J Emerg Med. 2015; 48: 527-535
      1. MMWR Morb Mortal Wkly Rep. 2005; 54: 113-117
        • Wolf S.J.
        • Lo B.
        • Shih R.D.
        • Smith M.D.
        • Fesmire F.M.
        Clinical policy: critical issues in the evaluation and management of adult patients in the emergency department with asymptomatic elevated blood pressure.
        Ann Emerg Med. 2013; 62: 59-68
        • Tilman K.
        • Delashaw M.
        • Lowe S.
        • Springer S.
        • Hundley S.
        • Counselman F.L.
        Recognizing asymptomatic elevated blood pressure in ED patients: how good (bad) are we?.
        Am J Emerg Med. 2007; 25: 313-317
        • Broadbent E.
        • Petrie K.J.
        • Main J.
        • Weinman J.
        The brief illness perception questionnaire.
        J Psychosom Res. 2006; 60: 631-637
      2. IBM Corp. Released 2012. IBM SPSS statistics for windows, Version 22.0. Armonk, NY: IBM Corp.

        • McCormick Patrick
        • Joseph Thomas
        Medicalrisk: medical risk and comorbidity tools for ICD-9-CM data.
        in: R package version 1.2. 2016
        • Umscheid C.A.
        • Maguire M.G.
        • Pines J.M.
        • et al.
        Untreated hypertension and the emergency department: a chance to intervene?.
        Acad Emerg Med. 2008; 15: 529-536
        • Shah T.
        • Aronow W.S.
        • Peterson S.J.
        • Goldwag D.
        Diagnosis, treatment, and referral of hypertension or prehypertension in an emergency department after an educational program: preliminary results.
        J Clin Hypertens (Greenwich). 2011; 13: 413-415
        • Naderi S.
        • Barnett B.
        • Hoffman R.S.
        • et al.
        Factors associated with failure to follow-up at a medical clinic after an ED visit.
        Am J Emerg Med. 2012; 30: 347-351