Usefulness of systolic blood pressure combined with heart rate measured on admission to identify 1-year all-cause mortality risk in elderly patients firstly hospitalized due to acute heart failure

2019 ◽  
Vol 32 (1) ◽  
pp. 99-106
Author(s):  
Rafael Moreno-González ◽  
Francesc Formiga ◽  
Jose María Mora Lujan ◽  
David Chivite ◽  
Albert Ariza-Solé ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Elderly Patients ◽  
Systolic Blood Pressure ◽  
Acute Heart Failure ◽  
Mortality Risk ◽  
All Cause Mortality

P4548Early drop in systolic blood pressure and worsening renal function in the elderly acute heart failure: how does heart rate interact?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Takeuchi ◽  
M Nagai ◽  
K Dote ◽  
M Kato ◽  
N Oda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Renal Function ◽  
Systolic Blood Pressure ◽  
Acute Heart Failure ◽  
The Elderly ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Worsening Renal Function

Abstract Background Renal dysfunction is a frequent finding in patients hospitalized for acute heart failure (AHF). Worsening renal function (WRF) during hospitalization was found to be related with a poor outcome independently of baseline renal function. Early drop in systolic blood pressure (SBP) has shown to predict WRF in AHF. However, there have been few studies that reported the impact of on-admission heart rate (HR) on the relationship between early SBP drop and WRF in the elderly AHF. Purpose We assessed the hypothesis that early SBP drop predict WRF in the elderly patients with AHF, and investigated that on-admission HR might have an interaction with that relationship. Methods SBP and HR were measured on admission and 6 times during 48 hours in the 245 elderly AHF inpatients (82.9±6.0 years old, male 49.4%). WRF was defined as a serum creatinine increase of ≥0.3 mg/dL by Day 5. Early drop in SBP was calculated as the difference between admission and the lowest value measured during the first 48 hour of hospitalization. Results Early SBP drop (51.3 vs 32.5mmHg, p<0.01) and on-admission HR (79.3 vs 89.6bpm, p<0.05) were significantly different between the group with WRF (n=36) and the group without WRF (n=209). In the multiple logistic regression analysis adjusted for the confounders including age, gender, hypertension, left ventricular ejection fraction, total cholesterol, BNP, baseline creatinine, beta-blockade use, intravenous loop diuretic, isosorbide dinitrate and carperitide use, early SBP drop (OR: 1.003, 95% CI: 1.003–1.03, p<0.04) and on-admission HR (OR: 0.98, 95% CI: 0.96–0.99, p<0.01) were significantly associated with WRF. The interaction term of early SBP drop by on-admission HR did not have a significant association with WRF (p=0.3). Conclusions In the elderly AHF patients, exaggerated early SBP drop and lower on-admission HR were shown as significant independent predictors of WRF. These two factors were additively associated with WRF. Too much reduction in SBP and that in HR might be harmful to renal circulation in AHF.

scholarly journals Systolic Blood Pressure and Outcome in Patients Admitted With Acute Heart Failure: An Analysis of Individual Patient Data From 4 Randomized Clinical Trials

2021 ◽  
Author(s):  
Johannes Grand ◽  
Kristina Miger ◽  
Ahmad Sajadieh ◽  
Lars Køber ◽  
Christian Torp‐Pedersen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Acute Heart Failure ◽  
Left Ventricular Ejection ◽  
Long Term Outcomes ◽  
Short Term ◽  
End Point ◽  
All Cause Mortality

BACKGROUND In acute heart failure (AHF), systolic blood pressure (SBP) is an important clinical variable. This study assessed the association between SBP and short‐term and long‐term outcomes in a large cohort of patients with AHF. METHODS AND RESULTS This is an analysis of 4 randomized controlled trials investigating serelaxin versus placebo in patients admitted with AHF and SBPs from 125 to 180 mm Hg. Outcomes were 180‐day all‐cause mortality and a composite end point of all‐cause mortality, worsening heart failure, or hospital readmission for heart failure the first 14 days. Left ventricular ejection fraction (LVEF) was examined as LVEF<40% and LVEF≥40%. Multivariable Cox regression models were adjusted for known confounders of outcomes in AHF. A total of 10 533 patients with a mean age of 73 (±12) years and a mean SBP of 145 (±7) mm Hg were included. LVEF was assessed in 9863 patients (93%); 4737 patients (45%) had LVEF<40%. Increasing SBP was inversely associated with 180‐day mortality (adjusted hazard ratio [HR adjusted ], 0.93; 95% CI, 0.89–0.98; P =0.008 per 10 mm Hg increase) and with the composite end point (HR adjusted , 0.90; 95% CI, 0.85–0.94; P <0.001 per 10 mm Hg increase). A significant interaction with LVEF was observed, revealing that SBP was not associated with mortality in patients with LVEF≥40% (HR adjusted , 0.98; 95% CI, 0.91–1.04; per 10 mm Hg increase), but was strongly associated with increased mortality in LVEF<40% (HR adjusted , 0.84; 95% CI, 0.77–0.92; per 10 mm Hg increase). CONCLUSIONS Elevated SBP is associated with favorable short‐term and long‐term outcomes in patients with AHF. In our predefined subgroup analysis, we found that baseline SBP was not associated with mortality in LVEF≥40%, but was strongly associated with mortality in patients with LVEF<40%.

scholarly journals Early Drop in Systolic Blood Pressure and Worsening Renal Function in Elderly Patients With Acute Heart Failure: How Does the Heart Rate Interact?

2020 ◽  
Author(s):  
Makoto Takeuchi ◽  
Michiaki Nagai ◽  
Keigo Dote ◽  
Masaya Kato ◽  
Noboru Oda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Renal Function ◽  
Systolic Blood Pressure ◽  
Acute Heart Failure ◽  
Multiple Logistic Regression Analysis ◽  
Worsening Renal Function ◽  
The Difference ◽  
Poor Outcomes

Abstract Background: Regardless of patients' baseline renal function, worsening renal function (WRF) during hospitalization is associated with poor outcomes. In individuals with acute heart failure (AHF), one predictor of WRF is an early drop in systolic blood pressure (SBP). Few studies have investigated WRF in elderly AHF patients or the influence of these patients' at-admission heart rate (HR) on the relationship between an early SBP drop SBP and the AHF. Methods: We measured the SBP and HR of 245 elderly AHF inpatients (82.9±6.0 years old, females 50.6%) at admission and another six times over the next 48 hr. We defined 'WRF' as a serum creatinine increase ≥0.3 mg/dL by Day 5 post-admission. We calculated the 'early SBP drop' as the difference between the admission SBP value and the lowest value during the first 48 hr of hospitalization. Results: There were significant differences between the 36 patients with WRF and the 209 patients without WRF: early SBP drop (51.3 vs. 32.5 mmHg, p<0.01) and at-admission HR (79.3 vs. 89.6 bpm, p<0.05), respectively. In the multiple logistic regression analysis adjusted for the confounders, early SBP drop (OR: 1.003, 95%CI: 1.003–1.03, p<0.04) and HR at-admission (OR: 0.98, 95%CI: 0.96–0.99, p<0.01) were significantly associated with WRF. No significant association was shown for the interaction term of early SBP drop ´ at-admission HR with WRF (p=0.3). Conclusions: In these elderly AHF patients, exaggerated early SBP drop and lower at-admission HR were significant independent predictors of WRF, and these factors were additively associated with WRF.

Stratification of the Mortality Risk According to Heart Rate and Systolic Blood Pressure in Heart Failure Patients

2012 ◽  
Vol 18 (10) ◽  
pp. S165-S166
Author(s):  
Masanobu Miura ◽  
Yasuhiko Sakata ◽  
Kotaro Nochioka ◽  
Tsuyoshi Takada ◽  
Satoshi Miyata ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Mortality Risk ◽  
Heart Failure Patients

scholarly journals Systolic blood pressure reduction during the first 24 h in acute heart failure admission: friend or foe?

2017 ◽  
Vol 20 (2) ◽  
pp. 317-322 ◽  
Author(s):  
Gad Cotter ◽  
Marco Metra ◽  
Beth A. Davison ◽  
Guillaume Jondeau ◽  
John G.F. Cleland ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Acute Heart Failure ◽  
Blood Pressure Reduction ◽  
Pressure Reduction ◽  
Heart Failure Admission

scholarly journals Synergistic Impact of Systolic Blood Pressure and Perfusion Status on Mortality in Acute Heart Failure

2021 ◽  
Vol 14 (3) ◽  
Author(s):  
Xavier Rossello ◽  
Héctor Bueno ◽  
Víctor Gil ◽  
Javier Jacob ◽  
Francisco Javier Martín-Sánchez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Physical Examination ◽  
Systolic Blood Pressure ◽  
Acute Heart Failure ◽  
Positive Association ◽  
Prognostic Impact ◽  
Inverse Association ◽  
Logistic Regression Models ◽  
Short Term Mortality

Background: Physical examination remains the cornerstone in the assessment of acute heart failure. There is a lack of adequately powered studies assessing the combined impact of both systolic blood pressure (SBP) and hypoperfusion on short-term mortality. Methods: Patients with acute heart failure from 41 Spanish emergency departments were recruited consecutively in 3 time periods between 2011 and 2016. Logistic regression models were used to assess the association of 30-day mortality with SBP (<90, 90–109, 110–129, and ≥130 mm Hg) and with manifestations of hypoperfusion (cold skin, cutaneous pallor, delayed capillary refill, livedo reticularis, and mental confusion) at admission. Results: Among 10 979 patients, 1143 died within the first 30 days (10.2%). There was an inverse association between 30-day mortality and initial SBP (35.4%, 18.9%, 12.4%, and 7.5% for SBP<90, SBP 90–109, SBP 110–129, and SBP≥130 mm Hg, respectively; P <0.001) and a positive association with hypoperfusion (8.0%, 14.8%, and 27.6% for those with none, 1, ≥2 signs/symptoms of hypoperfusion, respectively; P <0.001). After adjustment for 11 risk factors, the prognostic impact of hypoperfusion on 30-day mortality varied across SBP categories: SBP≥130 mm Hg (odds ratio [OR]=1.03 [95% CI, 0.77–1.36] and OR=1.18 [95% CI, 0.86–1.62] for 1 and ≥2 compared with 0 manifestations of hypoperfusion), SBP 110 to 129 mm Hg (OR=1.23 [95% CI, 0.86–1.77] and OR=2.18 [95% CI, 1.44–3.31], respectively), SBP 90 to 109 mm Hg (OR=1.29 [95% CI, 0.79–2.10] and OR=2.24 [95% CI, 1.36–3.66], respectively), and SBP<90 mm Hg (OR=1.34 [95% CI, 0.45–4.01] and OR=3.22 [95% CI, 1.30–7.97], respectively); P -for-interaction =0.043. Conclusions: Hypoperfusion confers an incremental risk of 30-day all-cause mortality not only in patients with low SBP but also in normotensive patients. On admission, physical examination plays a major role in determining prognosis in patients with acute heart failure.

Sign in / Sign up

Export Citation Format

Share Document