Synergistic Impact of Systolic Blood Pressure and Perfusion Status on Mortality in Acute Heart Failure
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Published:2021-03
Issue:3
Volume:14
Page:
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ISSN:1941-3289
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Container-title:Circulation: Heart Failure
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language:en
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Short-container-title:Circ: Heart Failure
Author:
Rossello Xavier12ORCID, Bueno Héctor234ORCID, Gil Víctor56, Jacob Javier7ORCID, Martín-Sánchez Francisco Javier8ORCID, Llorens Pere9, Herrero Puente Pablo10ORCID, Alquézar-Arbé Aitor11ORCID, Espinosa Begoña9, Raposeiras-Roubín Sergio212ORCID, Müller Christian E.1314ORCID, Mebazaa Alexandre1415, Maggioni Aldo P.16ORCID, Pocock Stuart17, Chioncel Ovidiu1819ORCID, Miró Òscar514ORCID, Fuentes Marta, Gil Cristina, Alonso Héctor, Pérez-Llantada Enrique, García Guillermo Llopis, Cadenas Mar Suárez, Escoda Rosa, Xipell Carolina, Sánchez Carolina, Pérez-Durá María José, Salvo Eva, Pavón José, Noval Antonio, Torres José Manuel, López-Grima María Luisa, Valero Amparo, Juan María Ángeles, Aguirre Alfons, Pedragosa Maria Àngels, Masó Silvia Mínguez, Alonso María Isabel, Ruiz Francisco, Franco José Miguel, Mecina Ana Belén, Tost Josep, Berenguer Marta, Donea Ruxandra, Ramón Susana Sánchez, Rodríguez Virginia Carbajosa, Piñera Pascual, Sánchez Nicolás José Andrés, Garate Raquel Torres, Rizzi Miguel Alberto, Herrera Sergio, Roset Alex, Cabello Irene, Haro Antonio, Richard Fernando, Álvarez Pérez José María, López Diez María Pilar, Puente Pablo HerreroORCID, Álvarez Joaquín Vázquez, García Belén Prieto, García María García, González Marta Sánchez, Javaloyes Patricia, Marquina Víctor, Jiménez Inmaculada, Hernández Néstor, Brouzet Benjamín, Andueza Juan Antonio, Romero Rodolfo, Ruíz Martín, Calvache Roberto, Lorca Serralta María Teresa, Calderón Jave Luis Ernesto, Arriaga Beatriz Amores, Bergua Beatriz Sierra, Mojarro Enrique Martín, Alarcón Jiménez Brigitte Silvana, Bécquer LisetteTravería, Burillo Guillermo, García Lluís Llauger, LaSalle Gerard Corominas, Urbano Carmen Agüera, García Soto Ana Belén, Padial Elisa Delgado, Ferrer Ester Soy, Garrido José Manuel, Lucas-Imbernón Francisco Javier, Gaya Rut, Bibiano Carlos, Mir María, Rodríguez Beatriz, Carballo José Luis, Rodríguez-Adrada Esther, Miranda Belén Rodríguez
Affiliation:
1. Cardiology Department, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma (X.R.). 2. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (X.R., H.B. S.R.-R.). 3. Instituto de Investigación i+12, Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain (H.B.). 4. Facultad de Medicina (H.B.), Universidad Complutense de Madrid, Spain. 5. Emergency Department, Hospital Clínic, Barcelona (V.G., O.M.). 6. Emergencies: Processes and Pathologies Research Group, IDIBAPS, University of Barcelona (V.G., O.M.). 7. Emergency Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Catalonia (J.J.). 8. Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC) (F.J.M.-S.), Universidad Complutense de Madrid, Spain. 9. Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante (P.L., B.E.). 10. Emergency Department, Hospital Universitario Central de Asturias, Oviedo (P.H.P.). 11. Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia (A.A.-A.). 12. Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain (S.R.-R.). 13. Cardiovascular Research Institute Basel (CRIB) and Cardiology Department, University Hospital Basel, University of Basel, Switzerland (C.E.M.). 14. The GREAT (Global Research in Acute Cardiovascular Conditions Team) Network (C.E.M., A.M., O.M.). 15. InsermU942 – MASCOT, Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisière University Hospital, Université Paris Diderot, France (A.M.). 16. ANMCO Research Center, Heart Care Foundation, Florence, Italy (A.P.M.). 17. Department of Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.P.). 18. Emergency Institute for Cardiovascular Diseases Prof. C.C. Iliescu, Bucharest, Romania (O.C.). 19. University of Medicine Carol Davila, Bucharest, Romania (O.C.).
Abstract
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.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
19 articles.
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