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 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 Early drop in systolic blood pressure and worsening renal function in acute heart failure: renal results of Pre-RELAX-AHF

2011 ◽  
Vol 13 (9) ◽  
pp. 961-967 ◽  
Author(s):  
Adriaan A. Voors ◽  
Beth A. Davison ◽  
G. Michael Felker ◽  
Piotr Ponikowski ◽  
Elaine Unemori ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Renal Function ◽  
Systolic Blood Pressure ◽  
Acute Heart Failure ◽  
Worsening Renal Function

scholarly journals Management of acute heart failure and the effect of systolic blood pressure on the use of intravenous therapies

2013 ◽  
Vol 2 (3) ◽  
pp. 219-225 ◽  
Author(s):  
Tuukka Tarvasmäki ◽  
Veli-Pekka Harjola ◽  
Jukka Tolonen ◽  
Krista Siirilä-Waris ◽  
Markku S Nieminen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Acute Heart Failure

Angiopoietin-Like Protein 7 and Short-Term Mortality in Acute Heart Failure

2020 ◽  
Vol 10 (2) ◽  
pp. 116-124 ◽  
Author(s):  
Chongyu Zhang ◽  
Xin He ◽  
Jingjing Zhao ◽  
Yalin Cao ◽  
Jian Liu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Inflammatory Responses ◽  
Statistical Significance ◽  
Serum Levels ◽  
Enzyme Linked Immunosorbent Assay ◽  
Short Term ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Short Term Mortality

Introduction: Angiopoietin-like protein 7 (ANGPTL7) is involved in extracellular matrix expression and inflammatory responses. However, the prognostic utility of ANGPTL7 among patients with acute heart failure (AHF) remains unclear. Objective: To evaluate the association between ANGPTL7 and short-term mortality due to AHF. Methods and Results: Patients with AHF were prospectively studied. Serum levels of ANGPTL7 were measured by an enzyme-linked immunosorbent assay. Associations between 30- and 90-day mortality and tertiles of ANGPTL7 were assessed by multivariate logistic regression models. The study comprised 142 patients. Median patient age was 68 years, and 69.7% were male. There were 20 deaths within 30 days and 37 deaths within 90 days. Crude rates of 30-day mortality in low, intermediate, and high tertiles of ANGPTL7 were 4.6, 14.6, and 22.9%, respectively. Crude rates of 90-day mortality of corresponding tertiles were 15.2, 25.0, and 37.5%. After adjusting for potential confounders, including NT-proBNP, the high tertile of ANGPTL7 was associated with a significantly increased risk of both 30-day mortality (odds ratio [OR]: 6.77, 95% confidence interval [CI]: 1.41–32.61, p = 0.017) and 90-day mortality (OR: 3.78, 95% CI: 1.38–10.36, p = 0.010) compared with the low tertile of ANGPTL7. Although mortality risk tended to be higher in the intermediate tertile than the low tertile, it did not reach statistical significance (OR: 3.75, 95% CI: 0.73–19.14, p = 0.113 for 30-day mortality; OR: 1.88, 95% CI: 0.66–5.34, p = 0.236 for 90-day mortality). Conclusions: Serum level of ANGPTL7 was independently associated with short-term mortality among patients with AHF.

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