ABSTRACT
BACKGROUND: The SARS-CoV-2 pandemic modified how persons got into contact with emergency services, particularly during the first wave. AIM: The aim is to describe the characteristics of older persons with and without COVID-19 visiting the Emergency Department of a tertiary hospital and to investigate the impact of age on in-hospital survival in the two groups. METHODS: Patients older than 70 years were followed-up till discharge or in-hospital death. Cox regression models stratified by COVID-19 diagnosis were used to investigate survival. RESULTS: Out of 896 patients, 36.7% had COVID-19. Those without COVID-19 were older and affected by a higher number of chronic conditions but exhibited lower mortality (10.5 vs 48.1%). After the adjustment, age was associated with mortality only among those with COVID-19. DISCUSSION: COVID-19 modified the relationship between older age and in-hospital survival: whether this finding is explained by other biological vulnerabilities or by a selection of treatments based on age should be further investigated.
Subject(s)
COVID-19 , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19 Testing , Emergency Service, Hospital , Hospital Mortality , Humans , Retrospective Studies , SARS-CoV-2 , Tertiary Care CentersABSTRACT
BACKGROUND: At present, few data are available on the prognosis of hypertensive emergencies and urgencies admitted to emergency departments. AIM: The aim of our study was to evaluate the incidence of total and cardiovascular events during follow-up in hypertensive patients admitted to the emergency departments of Brescia Hospital (Northern Italy) with hypertensive emergencies or urgencies from 1 January to 31 December 2015. METHODS: Medical records of patients aged more than 18 years, admitted to the emergency department with SBP values at least 180âmmHg (SBP) and/or DBP values at least 120âmmHg (DBP) were collected and analysed (18% of patients were classified as 'hypertensive emergency' and 82% as 'hypertensive urgency'). Data in 895 patients (385 men and 510 women, mean age 70. 5â±â15âyears) were analysed; the mean duration of follow-up after admission to the emergency department was 12â±â5âmonths. RESULTS: During the follow-up, 96 cardiovascular events (28 fatal) occurred (20 cardiac events, 30 cerebrovascular events, 26 hospital admission for heart failure, 20 cases of new onset kidney disease). In 40 patients (4.5%), a new episode of acute blood pressure rise with referral to the emergency department was recorded. Cardiovascular mortality and morbidity were greater in patients with a previous hypertensive emergency (14.5 vs. 4.5% in patients with hypertensive emergency and urgency, respectively, chi-square, Pâ<â0.0001). Similar results were obtained when the occurrence of cerebrovascular or renal events were considered separately. CONCLUSION: Admission to the emergency department for hypertensive emergencies and urgencies identifies hypertensive patients at increased risk for fatal and nonfatal cardiovascular events. Our findings add some new finding suggesting that further research in this field should be improved aiming to define, prevent, treat and follow hypertensive urgencies and emergencies.
Subject(s)
Hypertension, Malignant , Hypertension , Aged , Antihypertensive Agents/therapeutic use , Emergencies , Emergency Service, Hospital , Female , Humans , Hypertension/drug therapy , Hypertension, Malignant/drug therapy , Male , PrognosisABSTRACT
BACKGROUND: An increasing attention is given to emergency departments (EDs) admissions for an acute and severe rise in blood pressure (BP). Data on epidemiology and treatment of hypertensive emergencies and urgencies admitted to ED are still limited. The aim of our study was to evaluate the prevalence, clinical presentation and treatment of patients admitted for hypertensive emergencies or hypertensive urgencies. METHODS: Medical records of consecutive patients aged at least 18 years, admitted to the ED of the Spedali Civili in Brescia in 2008 and in 2015 and presenting with SBP at least 180âmmHg and/or DBP at least 120âmmHg were prospectively collected and analysed. RESULTS: The prevalence of patients admitted with acute BP rise was 2.0% (nâ=â1551, age 70â±â14 years) in 2008 and 1.75% (nâ=â1214, age 69.7â±â15 years) in 2015. According to the clinical presentation and the presence of acute organ damage, patients were defined hypertensive emergencies (20.4 and 15.4%, respectively, in 2008 and 2015) or as hypertensive urgencies (79.6 and 84.5%, respectively, in 2008 and 2015). SBP and DBP values were higher in patients with emergencies than in those with urgencies (BP 193â±â15/102â±â15 vs. 189â±â13/96â±â13âmmHg in 2008 and 192â±â17/98â±â15 vs. 189â±â12/94â±â15âmmHg in 2015, Pâ<â0.001 for both).Among hypertensive emergencies, the different forms of organ damage were 25% acute coronary syndromes and 1% aortic dissection in both periods, 34 and 38% acute heart failure, 40 and 37% stroke. CONCLUSION: Admission to the ED for hypertensive emergencies and hypertensive urgencies is still high. Diagnosis and treatment are still not appropriate and require the rapid application of recently published guidelines.
