Reynard Charles, van den Berg Patricia, Oliver Govind, Naguib Mina Peter, Sammut-Powell Camilla, McMillan Brian, Heagerty Anthony, Body Richard
Division of Cardiovascular Sciences, University of Manchester, Manchester, UK.
Emergency Department, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK.
Acad Emerg Med. 2022 Mar;29(3):344-353. doi: 10.1111/acem.14324. Epub 2021 Sep 22.
The objective was to assess the prognostic value of hypertension detected in the emergency department (ED).
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.
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.
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.
评估在急诊科（ED）检测到的高血压的预后价值。
急诊科提供了一个独特的机会来预测长期心血管疾病（CVD）的结局，因为其就诊人数众多，且能够对服务不足的患者群体进行大规模常规数据收集。我们进行了一项系统评价和荟萃分析，以评估急诊科测量的高血压作为长期CVD结局危险因素的预后性能和可行性。我们检索了MEDLINE和Embase数据库以及灰色文献来源。目标人群为未分化的急诊科患者。感兴趣的预后因素为高血压。可行性结局包括患病率、可靠性和随访参与情况。使用随机效应和精确似然法对可行性进行荟萃分析。
在标题和摘要审查后，检索到1072项研究，53项研究的全文被评估是否符合纳入标准，26项研究被纳入。发现存在显著异质性，可能是由于国际人群和不同的研究设计。急诊科测量的高血压患病率的荟萃分析估计值为0.31（95%置信区间0.25 - 0.37）。急诊科高血压在急诊科外持续存在（固定效应估计值为0.50）。随访患者的比例较低，精确似然估计值为0.41。三项研究考察了高血压的预后性能，结果表明长期CVD结局的风险增加。
高血压在急诊科可以被可行地测量，因此可用于长期心血管风险预测模型。利用常规收集的数据，有机会对目标个体进行干预。
