Justo Sánchez-Gil1, Luis Manzano2, Marcus Flather3, Francesc Formiga4, Alicia Conde Martel5, Alberto Muela Molinero6, Raul Quirós López7, Jose Luis Arias Jiménez8, Pau Llácer Iborra9, Juan Ignacio Perez-Calvo10, Manuel Montero-Pérez-Barquero11. 1. Department of Internal Medicine, IMIBIC/Hospital Reina Sofía, University of Córdoba, Spain. 2. Heart failure and Vascular Risk Unit, Department of Internal Medicine, Ramón y Cajal University Hospital, Universidad of Alcalá, Madrid, Spain. 3. Norwich Medical School, University of East Anglia and Norfolk and Norwich University Hospital, Norwich, UK. 4. Geriatric Unit, Department of Internal Medicine, IDIBELL, University Hospital of Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. 5. Department of Internal Medicine, University Hospital Dr Negrín, Las Palmas, De Gran Canaria, Spain. 6. Department of Internal Medicine, Hospital of León, León, Spain. 7. Department of Internal Medicine, Hospital Costa del Sol, Marbella, Spain. 8. Department of Internal Medicine, University Hospital of Virgen Macarena, Sevilla, Spain. 9. Department of Internal Medicine, Hospital of Manises, Valencia, Spain. 10. Department of Internal Medicine, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain. 11. Department of Internal Medicine, IMIBIC/Hospital Reina Sofía, University of Córdoba, Spain. Electronic address: fm1mopem@uco.es.
Abstract
OBJECTIVES: Heart rate (HR) and systolic blood pressure (SBP) are independent prognostic variables in patients with heart failure (HF). We evaluated if combining HR and SBP could improve prognostic assessment in older patients. METHODS: Variables associated with all-cause mortality and readmission for HF during 9months of follow-up were analyzed from the Spanish Heart Failure Registry (RICA). HR and SBP values were stratified in three combined groups. RESULTS: We evaluated 1551 patients, 82years and 56% women. Using HR strata of <70 and ≥70bpm we found mortality rates of 9.8 and 13.6%, respectively (hazard ratio 1.0 and 1.35). For SBP≥140, 120-140 and <120mmHg, mortality rates were 8.2, 10.4 and 20.3%. respectively (hazard ratio 1.0, 1.34 and 2.76). Using combined strata of HR<70bpm and SBP≥140mmHg (n=176; low-risk), HR<70 and SBP<140+HR≥70 and SBP<120 (n=1089; moderate-risk) and HR≥70 and SBP<120 (n=286; high-risk) we found mortality rates of 4.5%, 11.0% and 24.0%, respectively. Multivariate Cox regression for all-cause mortality shows for low-, middle- and high-risk groups was 1 (reference), 1.93 (95% CI: 0.93-3.99, p=0.077) and 4.32 (95% CI: 2.04-9.14, p<0.001). BMI, NYHA, MDRD, hypertension and sodium were also independent prognostic factors. CONCLUSIONS: The combination provides better risk discrimination than use of HR and SBP alone and may provide a simple and reliable tool for risk assessment for older HF patients in clinical practice.
OBJECTIVES: Heart rate (HR) and systolic blood pressure (SBP) are independent prognostic variables in patients with heart failure (HF). We evaluated if combining HR and SBP could improve prognostic assessment in older patients. METHODS: Variables associated with all-cause mortality and readmission for HF during 9months of follow-up were analyzed from the Spanish Heart Failure Registry (RICA). HR and SBP values were stratified in three combined groups. RESULTS: We evaluated 1551 patients, 82years and 56% women. Using HR strata of <70 and ≥70bpm we found mortality rates of 9.8 and 13.6%, respectively (hazard ratio 1.0 and 1.35). For SBP≥140, 120-140 and <120mmHg, mortality rates were 8.2, 10.4 and 20.3%. respectively (hazard ratio 1.0, 1.34 and 2.76). Using combined strata of HR<70bpm and SBP≥140mmHg (n=176; low-risk), HR<70 and SBP<140+HR≥70 and SBP<120 (n=1089; moderate-risk) and HR≥70 and SBP<120 (n=286; high-risk) we found mortality rates of 4.5%, 11.0% and 24.0%, respectively. Multivariate Cox regression for all-cause mortality shows for low-, middle- and high-risk groups was 1 (reference), 1.93 (95% CI: 0.93-3.99, p=0.077) and 4.32 (95% CI: 2.04-9.14, p<0.001). BMI, NYHA, MDRD, hypertension and sodium were also independent prognostic factors. CONCLUSIONS: The combination provides better risk discrimination than use of HR and SBP alone and may provide a simple and reliable tool for risk assessment for older HF patients in clinical practice.