Combining heart rate and systolic blood pressure to improve risk stratification in older patients with heart failure: Findings from the RICA Registry

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• 作者：Justo Sá ; nchez-Gil^a ; Luis Manzano^b ; Marcus Flather^c ; Francesc Formiga^d ; Alicia Conde Martel^e ; Alberto Muela Molinero^f ; Raul Quir&oacute ; s L&oacute ; pez^g ; Jose Luis Arias Jimé ; nez^h ; Pau Llá ; cer Iborraⁱ ; Juan Ignacio Perez-Calvo^j ; Manuel Montero-Pé ; rez-Barquero^a ; ^{fm1mopem@uco.es} ; on behalf of the RICA investigators
• 关键词：Heart failure ; Mortality ; Systolic blood pressure ; Heart rate ; RICA registry ; Prognosis
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 March 2017
• 年：2017
• 卷：230
• 期：Complete
• 页码：625-629
• 全文大小：397 K
• 卷排序：230

文摘

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.MethodsVariables associated with all-cause mortality and readmission for HF during 9 months of follow-up were analyzed from the Spanish Heart Failure Registry (RICA). HR and SBP values were stratified in three combined groups.ResultsWe evaluated 1551 patients, 82 years and 56% women. Using HR strata of < 70 and ≥ 70 bpm we found mortality rates of 9.8 and 13.6%, respectively (hazard ratio 1.0 and 1.35). For SBP ≥ 140, 120–140 and < 120 mm Hg, 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 < 70 bpm and SBP ≥ 140 mm Hg (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.ConclusionsThe 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.