.jpg "Hannah Chan, PharmD, RPh photo")
Hannah Chan, PharmD, RPh
Emergency Medicine Clinical Pharmacist Specialist
Baptist Hospitals of Southeast Texas
Beaumont, Texas
Disclosure information not submitted.
Brian Gulbis, PharmD
Clinical Pharmacist Specialist
Memorial Hermann Texas Medical Center, United States
Disclosure information not submitted.
Kristen Underbrink, PharmD
Pharmacy Resident
Memorial Hermann Texas Medical Center, United States
Disclosure information not submitted.
Sean Savitz, MD
Vascular Neurology Physician
UT-HEALTH, United States
Disclosure information not submitted.
Xiaoqian Jiang, PhD
Bioinformatics
Memorial Hermann - Texas Medical Center, United States
Disclosure information not submitted.
Kai Zhang, PhD
Bioinformatics
Memorial Hermann - Texas Medical Center, United States
Disclosure information not submitted.
Teresa Allison, BCCCP, BCPS, PharmD
Clinical Pharmacist Specialist
Memorial Hermann Texas Medical Center, United States
Disclosure information not submitted.
Title: Blood Pressure Management as a Barrier to Discharge After a Spontaneous Intracerebral Hemorrhage
Introduction: Uncontrolled blood pressure management (BPM) may serve as a barrier to discharge in ICH patients. The aim of this study was to assess the impact of BPM on length of stay (LOS) by observed/expected ratio (O/E).
Methods: A retrospective review of 605 ICH patients was conducted at a comprehensive stroke center 7/2017 to 7/2020. The primary outcome was the percentage of patients with LOS O/E ratio ≥ 0.8. Factors associated with delayed hospital discharge (DHD) were evaluated. Chi-square, Mann-Whitney U test, and RuleFit algorithm were used for analysis.
Results: Patients had a mean (SD) age of 61 (14) years, median (IQR) NIHSS 11 (3, 18), median (IQR) ICH score 1 (0, 2), hypertension (80%), and 50% were on home blood pressure (BP) medications. A LOS O/E ratio of ≥ 0.8 was observed in 254 (44%) patients. Reasons for DHD included BPM (34%), disposition (28%), stroke management (20%), and medical management (18%). Patients with DHD had an initial mean (SD) SBP of 169 (36) mmHg vs. 165 (36) mmHg in patients with no DHD, p=0.374. On admission, 45% patients with DHD vs. 55% with no DHD were initiated on a nicardipine drip, p = 0.052. Oral BP therapy was initiated at a median (IQR) DHD; 18 hours (11, 28) vs. no DHD; 21 hours (12, 34), p = 0.145. Titration of oral medications from initial therapy occurred at a median DHD; 19 (8, 27) hours vs. no DHD 15 (7, 24), p=0.015. Reasons for DHD from BP-specific therapy included slow medication titration (41%), delayed therapy initiation (37%), titration intolerability (20%), and lack of enteral access (2%). There was a difference in the incidence of hypotension between groups. The RuleFit algorithm identified patient variables at higher risk for DHD based on a machine learning model and levels of importance. Factors assigned higher levels of importance that significantly contributed to DHD included lower admission GCS, lower BP at discharge, disposition to rehabilitation, and hospital stay in either the intermediate or stroke care unit.
Conclusion: In this cohort, BPM was one of the most significant factors in delaying discharge. The RuleFit algorithm identified other variables that may be associated with DHD and require further investigation. Protocols may be warranted to ensure better blood pressure control in patients with ICH.