Hypotension during hospitalization for acute heart failure is independently associated with 30-day mortality: findings from ASCEND-HF

Patel, P. A. et al. (2014) Hypotension during hospitalization for acute heart failure is independently associated with 30-day mortality: findings from ASCEND-HF. Circulation: Heart Failure, 7(6), pp. 918-925. (doi: 10.1161/CIRCHEARTFAILURE.113.000872)

Abstract

Background—Outcomes associated with episodes of hypotension while hospitalized with acute decompensated heart failure are not well understood.<p></p> Methods and Results—Using data from Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF), we assessed factors associated with in-hospital hypotension and subsequent 30-day outcomes. Patients were classified as having symptomatic or asymptomatic hypotension. Multivariable logistic regression was used to determine factors associated with in-hospital hypotension, and Cox proportional hazards models were used to assess the association between hypotension and 30-day outcomes. We also tested for treatment interaction with nesiritide on 30-day outcomes and the association between in-hospital hypotension and renal function at hospital discharge. Overall, 1555 of 7141 (21.8%) patients had an episode of hypotension, of which 73.1% were asymptomatic and 26.9% were symptomatic. Factors strongly associated with in-hospital hypotension included randomization to nesiritide (odds ratio, 1.98; 95% confidence interval [CI], 1.76–2.23; P<0.001), chronic metolazone therapy (odds ratio, 1.74; 95% CI, 1.17–2.60; P<0.001), and baseline orthopnea (odds ratio, 1.31; 95% CI, 1.13–1.52; P=0.001) or S3 gallop (odds ratio, 1.21; 95% CI, 1.06–1.40; P=0.006). In-hospital hypotension was associated with increased hazard of 30-day mortality (hazard ratio, 2.03; 95% CI, 1.57–2.61; P<0.001), 30-day heart failure hospitalization or mortality (hazard ratio, 1.58; 95% CI, 1.34–1.86; P<0.001), and 30-day all-cause hospitalization or mortality (hazard ratio, 1.40; 95% CI, 1.22–1.61; P<0.001). Nesiritide had no interaction on the relationship between hypotension and 30-day outcomes (interaction P=0.874 for death, P=0.908 for death/heart failure hospitalization, P=0.238 death/all-cause hospitalization).<p></p> Conclusions—Hypotension while hospitalized for acute decompensated heart failure is an independent risk factor for adverse 30-day outcomes, and its occurrence highlights the need for modified treatment strategies.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McMurray, Professor John
• Authors: Patel, P. A., Heizer, G., O'Connor, C. M., Schulte, P. J., Dickstein, K., Ezekowitz, J. A., Armstrong, P. W., Hasselblad, V., Mills, R. M., McMurray, J. J.V., Starling, R. C., Tang, W.H. W., Califf, R. M., and Hernandez, A. F.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Circulation: Heart Failure
• Publisher: Lippincott Williams and Wilkins
• ISSN: 1941-3289