Amanda K Verma1, Jie-Lena Sun2, Adrian Hernandez3, John R Teerlink4, Phillip J Schulte5, Justin Ezekowitz6, Adriaan Voors7, Randall Starling8, Paul Armstrong6, Christopher M O'Conner3, Robert J Mentz3. 1. Department of Cardiology, Washington University School of Medicine, St. Louis, Missouri. 2. Department of Statistics, Duke University Medical Center, Durham, North Carolina. 3. Department of Cardiology, Duke Clinical Research Institute, Duke Hospital, Durham, North Carolina. 4. Department of Cardiology, School of Medicine, University of California, San Francisco. 5. Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota. 6. Division of Cardiology, University of Alberta, Edmonton, Canada. 7. Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands. 8. Department of Cardiology, Cleveland Clinic, Cleveland, Ohio.
Abstract
BACKGROUND:Heart rate and systolic blood pressure (SBP) are prognostic markers in heart failure (HF) with reduced ejection fraction (HFrEF). Their combination in rate pressure product (RPP) as well as their role in heart failure with preserved ejection fraction (HFpEF) remains unclear. HYPOTHESIS: RPP and its components are associated with HFpEF outcomes. METHODS: We performed an analysis of Acute Study of Clinical Effectiveness of Nesiritide in Subjects With Decompensated Heart Failure (ASCEND-HF; http://www.clinicaltrials.gov NCT00475852), which studied 7141 patients with acute HF. HFpEF was defined as left ventricular ejection fraction ≥40%. Outcomes were assessed by baseline heart rate, SBP, and RPP, as well as the change of these variables using adjusted Cox models. RESULTS: After multivariable adjustment, in-hospital change but not baseline heart rate, SBP, and RPP were associated with 30-day mortality/HF hospitalization (hazard ratio [HR]: 1.17 per 5-bpm heart rate, HR: 1.20 per 10-mm Hg SBP, and HR: 1.02 per 100 bpm × mm Hg RPP; all P < 0.05). Baseline SBP was associated with 180-day mortality (HR: 0.88 per 10-mm Hg, P = 0.028). Though change in RPP was associated with 30-day mortality/HF hospitalization, the RPP baseline variable did not provide additional associative information with regard to outcomes when compared with assessment of baseline heart rate and SBP variables alone. CONCLUSIONS: An increase in heart rate and SBP from baseline to discharge was associated with increased 30-day mortality/HF hospitalization in HFpEF patients with acute exacerbation. These findings suggest value in monitoring the trend of vital signs during HFpEF hospitalization.
RCT Entities:
BACKGROUND: Heart rate and systolic blood pressure (SBP) are prognostic markers in heart failure (HF) with reduced ejection fraction (HFrEF). Their combination in rate pressure product (RPP) as well as their role in heart failure with preserved ejection fraction (HFpEF) remains unclear. HYPOTHESIS: RPP and its components are associated with HFpEF outcomes. METHODS: We performed an analysis of Acute Study of Clinical Effectiveness of Nesiritide in Subjects With Decompensated Heart Failure (ASCEND-HF; http://www.clinicaltrials.gov NCT00475852), which studied 7141 patients with acute HF. HFpEF was defined as left ventricular ejection fraction ≥40%. Outcomes were assessed by baseline heart rate, SBP, and RPP, as well as the change of these variables using adjusted Cox models. RESULTS: After multivariable adjustment, in-hospital change but not baseline heart rate, SBP, and RPP were associated with 30-day mortality/HF hospitalization (hazard ratio [HR]: 1.17 per 5-bpm heart rate, HR: 1.20 per 10-mm Hg SBP, and HR: 1.02 per 100 bpm × mm Hg RPP; all P < 0.05). Baseline SBP was associated with 180-day mortality (HR: 0.88 per 10-mm Hg, P = 0.028). Though change in RPP was associated with 30-day mortality/HF hospitalization, the RPP baseline variable did not provide additional associative information with regard to outcomes when compared with assessment of baseline heart rate and SBP variables alone. CONCLUSIONS: An increase in heart rate and SBP from baseline to discharge was associated with increased 30-day mortality/HF hospitalization in HFpEF patients with acute exacerbation. These findings suggest value in monitoring the trend of vital signs during HFpEF hospitalization.
Authors: M Packer; A J Coats; M B Fowler; H A Katus; H Krum; P Mohacsi; J L Rouleau; M Tendera; A Castaigne; E B Roecker; M K Schultz; D L DeMets Journal: N Engl J Med Date: 2001-05-31 Impact factor: 91.245
Authors: Barry A Borlaug; Vojtech Melenovsky; Stuart D Russell; Kristy Kessler; Karel Pacak; Lewis C Becker; David A Kass Journal: Circulation Date: 2006-11-06 Impact factor: 29.690
Authors: Peter M Okin; Richard B Devereux; Eva Gerdts; Steven M Snapinn; Katherine E Harris; Sverker Jern; Sverre E Kjeldsen; Stevo Julius; Jonathan M Edelman; Lars H Lindholm; Björn Dahlöf Journal: Circulation Date: 2006-03-13 Impact factor: 29.690
Authors: Michael J Domanski; Heidi Krause-Steinrauf; Barry M Massie; Prakash Deedwania; Dean Follmann; David Kovar; David Murray; Ron Oren; Yves Rosenberg; James Young; Michael Zile; Eric Eichhorn Journal: J Card Fail Date: 2003-10 Impact factor: 5.712