Background:
Prior research suggests that elevated BP in hospitalized patients represents true hypertension (HTN) and that HTN and cardiovascular risk factors are prevalent among inpatients. Providers often fail to recognize and intensify treatment regimens for uncontrolled hypertension, and nongeneralist providers generally do not perform as well as internists. Hospitalist consultation for surgical patients has the potential to improve care for HTN among surgical inpatients.
Methods:
We conducted a cross‐sectional pilot study to examine the relationship between hospitalist consultation and antihypertensive medication prescribing among surgical inpatients. Administrative data were used to identify a total of 2323 non‐ICU hypertensive adult surgical patients discharged during calendar year 2006. Diagnostic and pharmacy records were combined with physician billing records to identify patients receiving hospitalist consultation. Outcome variables of interest were: treatment with any antihypertensive medication and use of first‐line medications, defined as a thiazide diuretic, ACE inhibitor (ACE), beta‐blocker (BB), or calcium channel blocker (CCB).
Results:
Surgical patients had a mean age of 58.7 years, were 51% female, 36.7% Black, 62.1% white, and 51% Medicare, and had a median length of stay of 3 days. Overall, 14% of surgical patients received hospitalist consultation, and 78.8% of patients were treated with any antihypertensive during their hospital stay. The proportion of patients receiving antihypertensives varied significantly by their consult status (85% with consult vs. 77.6% without, P = .003). Among patients treated patients, the proportion receiving first‐line therapy was 68.6% overall. This proportion varied significantly by consult status (74% vs. 67.7%, P = .02). Among treated patients, 14.5% received thiazide, 27.7% ACE, 18.4% ARB, 65.5% BB, 10.6% nondihydropyridine CCB, 24% dihydropyridine CCB, 7.1% central alpha‐blocker, 20.6% direct vasodilator, and 3.6% alpha‐blocker.
Conclusions:
These preliminary data suggest a significant relationship between hospitalist consultation and antihypertensive prescribing among surgical inpatients. Analysis is limited by the absence of information on comorbid conditions and actual BP measures. Future research will use more robust data sets to control for potential confounders in order to demonstrate the value of hospitalists in the care of HTN and other chronic diseases among surgical inpatients.
Author Disclosure:
R. Neal Axon, none; D. Lackland, none; B. M. Egan, none.