Key result
Higher PAHR is linked to ~35% higher in-hospital mortality per 10 units in cardiogenic shock.
Why the study?
Higher RAP and lower MAP are linked to higher in-hospital mortality in cardiogenic shock, but the prognostic significance of pressure-adjusted heart rate (PAHR) has not been assessed.
Does a higher presenting pressure-adjusted heart rate (PAHR) predict a higher risk of in-hospital mortality and systemic hypoperfusion in patients admitted to the CICU with cardiogenic shock?
Cohort (n=1,411)
Yes
Does a higher presenting pressure-adjusted heart rate (PAHR) predict a higher risk of in-hospital mortality and systemic hypoperfusion in patients admitted to the CICU with cardiogenic shock?
In patients with cardiogenic shock, invasively measured pressure-adjusted heart rate (PAHR) is independently associated with in-hospital mortality and systemic hypoperfusion, outperforming its individual components and standard hemodynamic indices, though the simplified RAP/MAP ratio showed an even stronger association with mortality.
Answers are grounded in this paper and cite their sources.
PAHR may aid risk stratification in cardiogenic shock; leaves open whether it guides therapy or improves outcomes.
BACKGROUND: Among patients with cardiogenic shock (CS), higher right atrial pressure (RAP) and lower mean arterial pressure (MAP) are associated with higher in-hospital mortality. Pressure-adjusted heart rate (PAHR), defined as heart rate × RAP/MAP, integrates these parameters. The prognostic significance of PAHR has not been assessed in patients with CS. OBJECTIVES: The authors aimed to assess if PAHR values are associated with risk of in-hospital mortality in patients with CS. METHODS: CCCTN (Critical Care Cardiology Trials Network) is a multinational registry of cardiac intensive care units coordinated by the TIMI Study Group. Among CS admissions (2018-2023) undergoing invasive hemodynamic assessment within 24 hours of cardiac intensive care unit admission, we assessed the relationship of PAHR with in-hospital mortality. Patients with concurrent mechanical circulatory support were excluded in the primary analysis. ORs were adjusted for age, sex, vasoactive-inotropic score, Society for Cardiovascular Angiography and Interventions (SCAI) stage, and preceding cardiac arrest. RESULTS: Among the 1411 CS admissions in the analysis (18% with acute myocardial infarction), 75% were receiving vasoactive support at the time of assessment. Median heart rate was 92 beats/min, RAP 15 mm Hg, MAP 75 mm Hg, and PAHR 17. There was a stepwise gradient of higher in-hospital mortality with higher presenting PAHR values. In adjusted models, a higher PAHR was incrementally associated with higher in-hospital mortality (adjusted OR per 10 units: 1.35 [95% CI: 1.15-1.58]), and PAHR had stronger prognostic associations with mortality than its individual hemodynamic components. CONCLUSIONS: PAHR, a simple hemodynamic index calculated from vital signs and central venous pressure, is strongly associated with in-hospital mortality in CS.
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Ginder et al. (2025) conducted a cohort in Cardiogenic shock (n=1,411). Pressure-adjusted heart rate (PAHR = heart rate × RAP/MAP), evaluated per 10-unit increment and across categories (<10, 10-<20, 20-<30, ≥30 U) vs. Lower PAHR values (continuous per 10-unit change, or reference category PAHR <10) was evaluated on In-hospital death from any cause (Adjusted OR 1.35 per 10 units, 95% CI 1.15-1.58). Higher pressure-adjusted heart rate (PAHR) was independently associated with increased in-hospital mortality in cardiogenic shock (adjusted OR 1.35 per 10 units; 95% CI 1.15-1.58).
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