4.6 Article

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

Journal

CIRCULATION-HEART FAILURE
Volume 14, Issue 3, Pages 312-323

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCHEARTFAILURE.120.007347

Keywords

blood pressure; heart failure; mortality; prognosis

Funding

  1. SEC-CNIC CARDIOJOVEN fellowship program
  2. Instituto de Salud Carlos III
  3. Spanish Ministry of Health [PI15/01019, PI15/00773, PI18/00393, PI18/00456]
  4. FEDER [PI15/01019, PI15/00773, PI18/00393, PI18/00456]
  5. Fundacio La Marato de TV3 [2015/2510]
  6. Catalonian Government for Consolidated Groups of Investigation [GRC 2009/1385, 2014/0313, 2017/1424]

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The study found that in patients with acute heart failure, 30-day mortality is closely associated with systolic blood pressure and manifestations of hypoperfusion, with hypoperfusion increasing the risk of 30-day all-cause mortality not only in patients with low systolic blood pressure but also in normotensive patients. On admission, physical examination plays a major role in determining prognosis in patients with acute heart failure.
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.

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