Previous studies have highlighted differences in disease distribution among men and women hospitalized with CVD and sex disparities in hospital treatments and subsequent clinical outcomes. However, as these studies are limited to inpatients, they do not account for differential propensity to hospitalize men and women. Furthermore, they overlook the highest‐risk patients who may not survive the first medical contact before admission.
A new study by the top cardiovascular (CVD) diagnoses from U.S. emergency departments suggest that many cardiovascular emergencies are due to poorly controlled high blood pressure. The study of more than 20 million emergency department visits- suggests that ‘essential’ hypertension, or high blood pressure not induced by other conditions, accounted for 13% of all heart-related emergency room diagnoses. Most cases of high blood pressure are essential hypertension.
Lead author Mamas A. Mamas, M.D., a professor of cardiology at Keele University in Stoke-on-Trent, said, “These visits resulted in hospital admission less than 3% of the time and with very few deaths – less than 0.1%. This suggests that these visits were mainly related to the management of hypertension.”
Of the 15 CVD conditions detailed in the study, about 30% were hypertension-related diagnoses.
Scientists analyzed primary cardiovascular encounters from the Nationwide Emergency Department Sample between 2016 and 2018. The sample included 48.7% women; the median age was 67. Men had a greater overall baseline comorbidity burden; however, women had higher rates of obesity, hypertension, and cerebrovascular disease. For women, the most common emergency department encounters were essential hypertension (16.0%), hypertensive heart or kidney disease (14.1%), and atrial fibrillation/flutter (10.2%). For men, the most common encounters were hypertensive heart or kidney disease (14.7%), essential hypertension (10.8%), and acute myocardial infarction (10.7%).
Mamas said, “Previous studies have shown sex differences in patterns of CVD among hospitalized patients. However, examining CVD encounters in the emergency department provides a complete picture of the cardiovascular health care needs of men and women, as it captures encounters before hospitalization.”
“Previous studies of CVD emergency visits are limited to suspected heart attack visits. Therefore, this analysis of 15 CVD conditions helps better understand the full spectrum of acute CVD needs, including sex disparities in hospitalization and risk of death.”
“The study found that outcomes from the emergency CVD visits were slightly different for men and women. Overall, women were less likely to die (3.3% of women vs. 4.3% of men) or be hospitalized (49.1% of women vs. 52.3% of men) after an emergency department visit for CVD. The difference may be due to women’s generally lower risk diagnoses, but there could be an underestimation of deaths in women.”
“We did not track deaths outside of the hospital setting. Given past evidence that women are more likely to be inappropriately discharged from the emergency department, and strong evidence for the systemic undertreatment of women, further study is warranted to track outcomes beyond the emergency department visit.”
“Our work with this large, nationally representative sample of cardiovascular emergency visits highlights differences in health care needs of men and women, which may be useful to inform planning and provision of health care services. We also encourage further research into understanding the underlying factors driving the differences in CVD patterns and outcomes between men and women.”
- Zahra Raisi‐Estabragh et al. Differential Patterns and Outcomes of 20.6 Million Cardiovascular Emergency Department Encounters for Men and Women in the United States. Journal of the American Heart Association. DOI: 10.1161/JAHA.122.026432