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    The prognostic value of emergency department measured hypertension: A systematic review and meta‐analysis

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    Authors
    Reynard, Charles; orcid: 0000-0002-7534-2668; email: Charles.reynard@postgrad.manchester.ac.uk
    van den Berg, Patricia; orcid: 0000-0001-8148-1130
    Oliver, Govind; orcid: 0000-0001-6051-6090
    Naguib, Mina Peter
    Sammut‐Powell, Camilla
    McMillan, Brian; orcid: 0000-0002-0683-3877
    Heagerty, Anthony; orcid: 0000-0002-9043-2119
    Body, Richard; orcid: 0000-0001-9089-8130
    Publication Date
    2021-09-22
    Submitted date
    2021-03-25
    
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    Abstract
    Abstract: Objectives: The objective was to assess the prognostic value of hypertension detected in the emergency department (ED). Methods: The ED presents a unique opportunity to predict long‐term cardiovascular disease (CVD) outcomes with its potential for high‐footfall, and large‐scale routine data collection applied to underserved patient populations. A systematic review and meta‐analyses were conducted to assess the prognostic performance and feasibility of ED‐measured hypertension as a risk factor for long‐term CVD outcomes. We searched MEDLINE and Embase databases and gray literature sources. The target populations were undifferentiated ED patients. The prognostic factor of interest was hypertension. Feasibility outcomes included prevalence, reliability, and follow‐up attendance. Meta‐analyses were performed for feasibility using a random effect and exact likelihood. Results: The searches identified 1072 studies after title and abstract review, 53 studies had their full text assessed for eligibility, and 26 studies were included. Significant heterogeneity was identified, likely due to the international populations and differing study design. The meta‐analyses estimate of prevalence for ED‐measured hypertension was 0.31 (95% confidence interval 0.25–0.37). ED hypertension was persistent outside the ED (FE estimate of 0.50). The proportion of patients attending follow‐up was low with an exact likelihood estimate of 0.41. Three studies examined the prognostic performance of hypertension and demonstrated an increased risk of long‐term CVD outcomes. Conclusion: Hypertension can be measured feasibly in the ED and consequently used in a long‐term cardiovascular risk prediction model. There is an opportunity to intervene in targeted individuals, using routinely collected data.
    Citation
    Academic Emergency Medicine
    URI
    http://hdl.handle.net/10034/625914
    Type
    article
    Description
    From Wiley via Jisc Publications Router
    History: received 2021-03-25, rev-recd 2021-06-07, accepted 2021-06-15, pub-electronic 2021-09-22
    Article version: VoR
    Publication status: Published
    Funder: Royal College of Emergency Medicine; Id: http://dx.doi.org/10.13039/501100007566
    Funder: National Institute of Health Research (UK)
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