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

Medientyp: E-Artikel
Titel: Synergistic Impact of Systolic Blood Pressure and Perfusion Status on Mortality in Acute Heart Failure
Beteiligte: Rossello, Xavier; Bueno, Héctor; Gil, Víctor; Jacob, Javier; Martín-Sánchez, Francisco Javier; Llorens, Pere; Herrero Puente, Pablo; Alquézar-Arbé, Aitor; Espinosa, Begoña; Raposeiras-Roubín, Sergio; Müller, Christian E.; Mebazaa, Alexandre; Maggioni, Aldo P.; Pocock, Stuart; Chioncel, Ovidiu; Miró, Òscar; Fuentes, Marta; Gil, Cristina; Alonso, Héctor; Pérez-Llantada, Enrique; García, Guillermo Llopis; Cadenas, Mar Suárez; Escoda, Rosa; Xipell, Carolina; [...]
Erschienen: Ovid Technologies (Wolters Kluwer Health), 2021
Erschienen in: Circulation: Heart Failure
Sprache: Englisch
DOI: 10.1161/circheartfailure.120.007347
ISSN: 1941-3289; 1941-3297
Schlagwörter: Cardiology and Cardiovascular Medicine
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Beschreibung: <jats:sec> <jats:title>Background:</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p> 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; <jats:italic>P</jats:italic> <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; <jats:italic>P</jats:italic> <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); <jats:italic>P</jats:italic> -for-interaction =0.043. </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>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.</jats:p> </jats:sec>
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