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Hypotension During Hospitalization for Acute Heart Failure Is Independently Associated With 30-Day Mortality: Findings from ASCEND-HF.
Circ Heart Fail. 2014 Oct 3;
Authors: Patel PA, Heizer G, O'Connor CM, Schulte PJ, Dickstein K, Ezekowitz JA, Armstrong PW, Hasselblad V, Mills RM, McMurray JJ, Starling RC, Tang WH, Califf RM, Hernandez AF
Abstract
BACKGROUND: -Outcomes associated with episodes of hypotension while hospitalized are not well understood.
METHODS AND RESULTS: -Using data from 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, 1555/7141 (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 [OR] 1.98, 95% confidence interval [CI] 1.76-2.23; p<0.001), chronic metolazone therapy (OR 1.74, 95% CI 1.17-2.60; p<0.001), and baseline orthopnea (OR 1.31, 95% CI 1.13-1.52; p=0.001) or S3 gallop (OR 1.21, 95% CI 1.06-1.40; p=0.006). In-hospital hypotension was associated with increased hazards of 30-day mortality (hazard ratio [HR] 2.03, 95% CI 1.57-2.61; p<0.001), 30-day heart failure (HF) hospitalization or mortality (HR 1.58, 95% CI 1.34-1.86; p<0.001), and 30-day all-cause hospitalization or mortality (HR 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/HF hospitalization, p=0.238 death/all-cause hospitalization).
CONCLUSIONS: -Hypotension while hospitalized for acute decompensated HF is an independent risk factor for adverse 30-day outcomes, and its occurrence highlights the need for modified treatment strategies. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00475852.
PMID: 25281655 [PubMed - as supplied by publisher]