scholarly journals Impact of early treatment with intravenous vasodilators and blood pressure reduction in acute heart failure

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000845 ◽  
Author(s):  
Takeshi Kitai ◽  
W H Wilson Tang ◽  
Andrew Xanthopoulos ◽  
Ryosuke Murai ◽  
Takafumi Yamane ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Acute Heart Failure ◽  
Early Treatment ◽  
Blood Pressure Reduction ◽  
Prognostic Significance ◽  
Unique Identifier ◽  
Clinical Trial Registration ◽  
Vasodilator Therapy ◽  
Early Presentation

ObjectiveAlthough vasodilators are used in acute heart failure (AHF) management, there have been no clear supportive evidence regarding their routine use. Recent European guidelines recommend systolic blood pressure (SBP) reduction in the range of 25% during the first few hours after diagnosis. This study aimed to examine clinical and prognostic significance of early treatment with intravenous vasodilators in relation to their subsequent SBP reduction in hospitalised AHF.MethodsWe performed post hoc analysis of 1670 consecutive patients enrolled in the Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure. Intravenous vasodilator use within 6 hours of hospital arrival and subsequent SBP changes were analysed. Outcomes were gauged by 1-year mortality and diuretic response (DR), defined as total urine output 6 hours posthospital arrival per 40 mg furosemide-equivalent diuretic use.ResultsOver half of the patients (56.0%) were treated with intravenous vasodilators within the first 6 hours. In this vasodilator-treated cohort, 554 (59.3%) experienced SBP reduction ≤25%, while 381 (40.7%) experienced SBP reduction >25%. In patients experiencing ≤25% drop in SBP, use of vasodilator was associated with greater DR compared with no vasodilators (p<0.001). Moreover, vasodilator treatment with ≤25% drop in SBP was independently associated with lower all-cause mortality compared with those treated without vasodilators (adjusted HR 0.74, 95% CI 0.57 to 0.96, p=0.028).ConclusionsIntravenous vasodilator therapy was associated with greater DR and lower mortality, provided SBP reduction was less than 25%. Our results highlight the importance in early administration of intravenous vasodilators without causing excess SBP reduction in AHF management.Clinical trial registrationURL: http://www.umin.ac.jp/ctr/ Unique identifier: UMIN000014105.

Blood Pressure Reduction in Hypertensive Acute Heart Failure

2021 ◽  
Vol 23 (2) ◽  
Author(s):  
Nicholas Harrison ◽  
Peter Pang ◽  
Sean Collins ◽  
Phillip Levy
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Acute Heart Failure ◽  
Blood Pressure Reduction ◽  
Pressure Reduction

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

Association of Early Blood Pressure Decrease and Renal Function With Prognosis in Acute Heart Failure

2021 ◽  
Author(s):  
Yuya Matsue ◽  
Iziah E. Sama ◽  
Douwe Postmus ◽  
Marco Metra ◽  
Barry H. Greenberg ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Renal Function ◽  
Acute Heart Failure ◽  
Blood Pressure Decrease ◽  
Pressure Decrease

Change in blood pressure during hospitalisation for acute heart failure predicts mortality

2010 ◽  
Vol 44 (6) ◽  
pp. 325-330 ◽  
Author(s):  
Per Svensson ◽  
Helena Sundberg ◽  
Lars H. Lund ◽  
Jan Östergren
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Acute Heart Failure

scholarly journals Newly Diagnosed Infection After Admission for Acute Heart Failure: From the KCHF Registry

2021 ◽  
Author(s):  
Yuta Seko ◽  
Takao Kato ◽  
Takeshi Morimoto ◽  
Hidenori Yaku ◽  
Yasutaka Inuzuka ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Acute Heart Failure ◽  
Newly Diagnosed ◽  
Post Discharge ◽  
Infection Group ◽  
Unique Identifier ◽  
Adjusted Risk ◽  
Coronary Syndrome

Background No studies have explored the association between newly diagnosed infections after admission and clinical outcomes in patients with acute heart failure. We aimed to explore the factors associated with newly diagnosed infection after admission for acute heart failure, and its association with in‐hospital and post‐discharge clinical outcomes. Methods and Results Among 4056 patients enrolled in the Kyoto Congestive Heart Failure registry, 2399 patients without any obvious infectious disease upon admission were analyzed. The major in‐hospital and post‐discharge outcome measures were all‐cause deaths. There were 215 patients (9.0%) with newly diagnosed infections during hospitalization, and 2184 patients (91.0%) without infection during hospitalization. The factors independently associated with a newly diagnosed infection were age ≥80 years, acute coronary syndrome, non‐ambulatory status, hyponatremia, anemia, intubation, and patients who were not on loop diuretics as outpatients. The newly diagnosed infection group was associated with a higher incidence of in‐hospital mortality (16.3% and 3.2%, P <0.001) and excess adjusted risk of in‐hospital mortality (odds ratio, 6.07 [95% CI, 3.61–10.19], P <0.001) compared with the non‐infection group. The newly diagnosed infection group was also associated with a higher 1‐year incidence of post‐discharge mortality (19.3% in the newly diagnosed infection group and 13.6% in the non‐infection group, P <0.001) and excess adjusted risk of post‐discharge mortality (hazard ratio, 1.49 [95% CI, 1.08–2.07], P =0.02) compared with the non‐infection group. Conclusions Elderly patients with multiple comorbidities were associated with the development of newly diagnosed infections after admission for acute heart failure. Newly diagnosed infections after admission were associated with higher in‐hospital and post‐discharge mortality in patients with acute heart failure. Registration URL: https://clinicaltrials.gov ; Unique identifier: NCT02334891.

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.

scholarly journals Prognostic value of biomarkers and co-morbidities in patients with acute heart failure: One-year follow-up study

2017 ◽  
Vol 145 (3-4) ◽  
pp. 118-123
Author(s):  
Dejan Petrovic ◽  
Marina Deljanin-Ilic ◽  
Sanja Stojanovic
Keyword(s):  
Heart Failure ◽  
Renal Failure ◽  
Chronic Renal Failure ◽  
Acute Heart Failure ◽  
Troponin I ◽  
Prognostic Significance ◽  
Systolic Pressure ◽  
High Sensitivity ◽  
Clinical Group ◽  
One Year

Introduction/Objective. Clinical risk stratification of patients hospitalized due to acute heart failure (AHF) applying B-type natriuretic peptide (BNP), troponin I (TnI), and high-sensitivity C-reactive protein (hsCRP) biochemical markers can contribute to early diagnosis of AHF and lower mortality rates. The aim of this study was to investigate the prognostic significance of biomarkers (BNP, TnI, and hsCRP) and co-morbidities concerning one-year mortality in patients with AHF. Methods. Clinical group comprised 124 consecutive unselected patients, age 60?80 years, treated at the Coronary Care Unit of the Niska Banja Institute, Nis. The patients were monitored for one year after the discharge. During the first 24 hours after admission, BNP, TnI, and hsCRP were measured in fasting serum. Results. Total one-year mortality was 29.8%. The levels of serum BNP were significantly higher in the group of non-survivors compared to the group of survivors (1353.8 ?} 507.8 vs. 718.4 ?} 387.6 pg/mL, p < 0.001). We identified several clinical and biochemical prognostic risk factors by univariate and multivariate analysis. Independent predictors of one-year mortality were the following: BNP, TnI, depression, hypotension, chronic renal failure, ejection fraction, and right-ventricle systolic pressure. Conclusion. The presence of BNP and TnI biomarkers and several co-morbidities such as depression or chronic renal failure have significant influence on one-year mortality in patients with AHF.

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