Thirty-Day Readmissions After Hospitalization for Hypertensive Emergency

Abstract

Hypertensive emergency is a clinical entity with potentially serious health implications and high healthcare utilization. There is a lack of nationally representative data on incidence, causes, and predictors of 30-day readmission after hospitalization for hypertensive emergency. We used the 2013–2014 Nationwide Readmissions Database to identify index hospitalizations for hypertensive emergency. Primary outcome was all-cause unplanned 30-day readmission. Multivariable hierarchical logistic regression was used to identify independent predictors of readmission. There were 166,531 index hospitalizations for hypertensive emergency representative of 355,627 (standard error 9,401) hospitalizations nationwide in 2013–2014. Mean age was 66.0 (standard error 0.14) years and 53.7% were women. The overall incidence of unplanned 30-day readmissions was 17.8%. The most common causes of readmission were heart failure (14.2%), hypertension with complications (10.2%), sepsis (5.9%), acute kidney injury (5.1%), and cerebrovascular accident (5.1%). Non-cardiovascular causes accounted for 57.9% of readmissions. We found age<65 years (odds ratio 1.21, 95% CI 1.17–1.25, p<0.001), female sex (odds ratio 1.09, 95% 1.07–1.12, p<0.001), comorbid disease burden, substance use disorders, and socioeconomic risk factors to be significant predictors of readmission. One out of six patients hospitalized for hypertensive emergency had an unplanned 30-day readmission. Heart failure, uncontrolled hypertension, and stroke were among the most frequent causes of readmission, however over half of all readmissions were due to non-cardiovascular causes.

Rehospitalization Rates in Hypertensive Emergency

“…The stereotype for hypertensive emergency, in the United States, is a young man without insurance, abusing street drugs, and leaving the hospital against medical advice. In this issue of Hypertension, Kumar et al show that the average age of the patient with hypertensive emergency in the United States is 66 years, more than half are women, only 5% abuse drugs and less than 2% sign out against medical advice (6). The vast majority of the patients with hypertensive emergency have health insurance and the disease is costly.…”

“…What are the risk factors for readmission? Kumar et al report many risk factors for readmission such as younger age (<65 years) and longer hospitalizations were associated with a greater risk for readmission (6). Although the risk of rehospitalization varies across the country for conditions such as acute heart failure and were not reported such variations probably exist even for acute hypertensive emergency.…”

“…Two risk factors at the time of index admission -- both highly prevalent and associated with high adjusted odds ratio for rehospitalization-- were notable (6). These included acute heart failure and chronic kidney disease (CKD).…”

“…Kumar et al tell us that hypertensive emergency is common, costly, and frequently results in rehospitalization (6). Clinicians, researchers and hospital administrators can all work together to reduce this common, costly, and morbid condition we call hypertensive emergency (Figure 1).…”

Modern Management of Hypertensive Emergencies

“…After admission, the treatment strategy is different according to the type of HE. Generally, it is recommended to reduce the BP by 25% in the first hour, then to below 160/100 mmHg over the next [2][3][4][5][6] hours, and then to normal over the next 24-48 hours. 21 However, in the presence of aortic dissection, pheochromocytoma, or severe preeclampsia or eclampsia, it is recommended to reduce the systolic BP to values lower than 140 mmHg in the first hour, and below 120 mmHg in aortic dissection.…”