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Randomized Controlled Trial
. 2014 Nov;7(6):918-25.
doi: 10.1161/CIRCHEARTFAILURE.113.000872. Epub 2014 Oct 3.

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

Priyesh A Patel  1 , Gretchen Heizer  2 , Christopher M O'Connor  2 , Phillip J Schulte  2 , Kenneth Dickstein  2 , Justin A Ezekowitz  2 , Paul W Armstrong  2 , Vic Hasselblad  2 , Roger M Mills  2 , John J V McMurray  2 , Randall C Starling  2 , W H Wilson Tang  2 , Robert M Califf  2 , Adrian F Hernandez  2
Affiliations
Randomized Controlled Trial

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

Priyesh A Patel et al. Circ Heart Fail. 2014 Nov.

Abstract

Background: Outcomes associated with episodes of hypotension while hospitalized with acute decompensated heart failure are not well understood.

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).

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.

Clinical trial registration url: http://www.clinicaltrials.gov. Unique identifier: NCT00475852.

Keywords: heart failure; hypotension; natriuretic peptide, brain.

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Figures

Figure 1
Figure 1
Time to first hypotensive episode from study randomization. Time from randomization in hours to any reported episode of hypotension among 1,555 patients with reported hypotension.
Figure 2
Figure 2
Median creatinine values among patients with versus without hypotension. Values represent the median creatinine values at various timepoints among the 1303 patients experiencing hypotension within 48 hours of randomization. Error bars represent interquartile range.
See this image and copyright information in PMC

References

    1. Voors AA, Davison BA, Felker GM, Ponikowski P, Unemori E, Cotter G, Teerlink JR, Greenberg BH, Filippatos G, Teichman SL, Metra M. Early drop in systolic blood pressure and worsening renal function in acute heart failure: Renal results of pre-relax-ahf. Eur J Heart Fail. 2011;13:961–967. - PubMed
    1. Blair JE, Pang PS, Schrier RW, Metra M, Traver B, Cook T, Campia U, Ambrosy A, Burnett JC, Jr, Grinfeld L, Maggioni AP, Swedberg K, Udelson JE, Zannad F, Konstam MA, Gheorghiade M. Changes in renal function during hospitalization and soon after discharge in patients admitted for worsening heart failure in the placebo group of the everest trial. Eur Heart J. 2011;32:2563–2572. - PubMed
    1. O’Connor CM, Starling RC, Hernandez AF, Armstrong PW, Dickstein K, Hasselblad V, Heizer GM, Komajda M, Massie BM, McMurray JJ, Nieminen MS, Reist CJ, Rouleau JL, Swedberg K, Adams KF, Jr, Anker SD, Atar D, Battler A, Botero R, Bohidar NR, Butler J, Clausell N, Corbalan R, Costanzo MR, Dahlstrom U, Deckelbaum LI, Diaz R, Dunlap ME, Ezekowitz JA, Feldman D, Felker GM, Fonarow GC, Gennevois D, Gottlieb SS, Hill JA, Hollander JE, Howlett JG, Hudson MP, Kociol RD, Krum H, Laucevicius A, Levy WC, Mendez GF, Metra M, Mittal S, Oh BH, Pereira NL, Ponikowski P, Tang WH, Tanomsup S, Teerlink JR, Triposkiadis F, Troughton RW, Voors AA, Whellan DJ, Zannad F, Califf RM. Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med. 2011;365:32–43. - PubMed
    1. Hernandez AF, O’Connor CM, Starling RC, Reist CJ, Armstrong PW, Dickstein K, Lorenz TJ, Gibler WB, Hasselblad V, Komajda M, Massie B, McMurray JJ, Nieminen M, Rouleau JL, Swedberg K, Califf RM. Rationale and design of the acute study of clinical effectiveness of nesiritide in decompensated heart failure trial (ASCEND-HF) Am Heart J. 2009;157:271–277. - PubMed
    1. Peterson PN, Rumsfeld JS, Liang L, Albert NM, Hernandez AF, Peterson ED, Fonarow GC, Masoudi FA. A validated risk score for in-hospital mortality in patients with heart failure from the american heart association get with the guidelines program. Circ Cardiovasc Qual Outcomes. 2010;3:25–32. - PubMed

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