November 7, 2006JAMA
Systolic Blood Pressure at Admission, Clinical Characteristics, and Outcomes in Patients Hospitalized With Acute Heart Failure
Why the study?
Does systolic blood pressure at admission predict in-hospital and postdischarge mortality in patients hospitalized with acute heart failure?
Population
48,612 patients aged 18 years or older hospitalized with acute heart failure at 259 US hospitals between…
Comparison
Systolic blood pressure at admission vs Comparison across SBP quartiles
Design
Cohort
Follow-up
In-hospital, and 60 to 90 days for a subgroup
Authors
Discussion
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Implication
Low admission SBP identifies higher-risk acute HF; supports risk stratification but leaves causal role and targets open.
Key Points
- To evaluate the relationship between systolic blood pressure at admission, clinical characteristics, and mortality outcomes in patients hospitalized for acute heart failure.
- Conducted a cohort study using the OPTIMIZE-HF registry across 259 US hospitals from March 2003 to December 2004, stratifying patients into admission systolic blood pressure quartiles (<120, 120–139, 140–161, and >161 mm Hg).
- Analyzed in-hospital outcomes in 48,612 patients aged 18 years or older (including 41,267 with assessed left ventricular function, 51% preserved) and 60- to 90-day postdischarge outcomes in a prespecified subgroup (n = 5,791).
- In-hospital mortality was inversely associated with admission systolic blood pressure: 7.2% for <120 mm Hg, 3.6% for 120–139 mm Hg, 2.5% for 140–161 mm Hg, and 1.7% for >161 mm Hg (P < .001).
- Postdischarge mortality at 60 to 90 days was significantly higher among patients with admission systolic blood pressure <120 mm Hg at 14.0%, compared with 8.4% (120–139 mm Hg), 6.0% (140–161 mm Hg), and 5.4% (>161 mm Hg) (P < .001).
Structured PICO
Does systolic blood pressure at admission predict in-hospital and postdischarge mortality in patients hospitalized with acute heart failure?
P
Population
48,612 patients aged 18 years or older hospitalized with acute heart failure at 259 US hospitals between March 2003 and December 2004.
I
Intervention
Systolic blood pressure (SBP) at admission (divided into quartiles: <120, 120-139, 140-161, and >161 mm Hg)
C
Comparator
Comparison across SBP quartiles
O
Outcome
In-hospital and postdischarge mortalityhard clinical
Low systolic blood pressure (<120 mm Hg) at admission for acute heart failure is an independent predictor of higher in-hospital and postdischarge mortality.
Cite This Study
Gheorghiade et al. (2006) studied this question.