Synergistic Impact of Systolic Blood Pressure and Perfusion Status on Mortality in Acute Heart Failure
Por:
Rossello, X, Bueno, H, Gil, V, Jacob, J, Martin-Sanchez, FJ, Llorens, P, Puente, PH, Alquezar-Arbe, A, Espinosa, B, Raposeiras-Roubin, S, Muller, CE, Mebazaa, A, Maggioni, AP, Pocock, S, Chioncel, O, Miro, O, ICA-SEMES Res Grp
Publicada:
1 mar 2021
Resumen:
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.
Filiaciones:
Rossello, X:
Hosp Univ Son Espases, Hlth Res Inst Balearic Isl IdISBa, Cardiol Dept, Palma De Mallorca, Spain
Ctr Nacl Invest Cardiovasc CNIC, Madrid, Spain
Bueno, H:
Ctr Nacl Invest Cardiovasc CNIC, Madrid, Spain
Hosp Univ 12 Octubre, Cardiol Dept, Inst Invest I 12, Madrid, Spain
Univ Complutense Madrid, Fac Med, Madrid, Spain
Gil, V:
Hosp Clinic, Emergency Dept, Villarroel 170, Barcelona 08036, Catalonia, Spain
Univ Barcelona, IDIBAPS, Emergencies Proc & Pathol Res Grp, Barcelona, Spain
Jacob, J:
Hosp Univ Bellvitge, Emergency Dept, Barcelona, Catalonia, Spain
Martin-Sanchez, FJ:
Univ Complutense Madrid, Inst Invest Sanitaria San Carlos IdISSC, Hosp Clin San Carlos, Emergency Dept, Madrid, Spain
Llorens, P:
Hosp Gen Alicante, Emergency Dept, Home Hospitalizat & Short Stay Unit, Alicante, Spain
Puente, PH:
Hosp Univ Cent Asturias, Emergency Dept, Oviedo, Spain
Alquezar-Arbe, A:
Hosp Santa Creu & Sant Pau, Emergency Dept, Barcelona, Catalonia, Spain
Espinosa, B:
Hosp Gen Alicante, Emergency Dept, Home Hospitalizat & Short Stay Unit, Alicante, Spain
Raposeiras-Roubin, S:
Ctr Nacl Invest Cardiovasc CNIC, Madrid, Spain
Univ Hosp Alvaro Cunqueiro, Dept Cardiol, Vigo, Spain
Muller, CE:
Univ Basel, Univ Hosp Basel, Cardiovasc Res Inst Basel CRIB, Basel, Switzerland
Univ Basel, Univ Hosp Basel, Cardiol Dept, Basel, Switzerland
GREAT Global REs Acute Cardiovasc Condit Team Net, Madrid, Spain
Mebazaa, A:
GREAT Global REs Acute Cardiovasc Condit Team Net, Madrid, Spain
Univ Paris Diderot, Dept Anesthesiol & Crit Care Med, St Louis Lariboisiere Univ Hosp, InsermU942 MASCOT, Paris, France
Maggioni, AP:
Heart Care Fdn, ANMCO Res Ctr, Florence, Italy
Pocock, S:
London Sch Hyg & Trop Med, Dept Med Stat, London, England
Chioncel, O:
Emergency Inst Cardiovasc Dis Prof CC Iliescu, Bucharest, Romania
Univ Med & Pharm Carol Davila, Bucharest, Romania
Miro, O:
Hosp Clinic, Emergency Dept, Villarroel 170, Barcelona 08036, Catalonia, Spain
Univ Barcelona, IDIBAPS, Emergencies Proc & Pathol Res Grp, Barcelona, Spain
GREAT Global REs Acute Cardiovasc Condit Team Net, Madrid, Spain
Bronze
|