Author + information
- Priyesh Ashok Patel,
- Gretchen Heizer,
- Christopher O'Connor,
- Kenneth Dickstein,
- Justin Ezekowitz,
- Victor Hasselblad,
- Barry Massie,
- Roger Mills,
- John McMurray,
- Randall Starling,
- Wai Hong Tang,
- Robert Califf and
- Adrian Hernandez
The prognostic significance of transient hypotension during hospitalization for acute decompensated heart failure (ADHF) is uncertain. We evaluated factors associated with hypotension and its relationship with 30-day (30d) outcomes in the ASCEND-HF trial (which randomized patients without baseline hypotension to nesiritide or placebo).
Hypotension episodes in ASCEND-HF were defined as symptomatic or asymptomatic per investigator. Stepwise logistic regression was used to identify baseline factors related to hypotension, and a Cox proportional hazards model was used to examine the relationship between hypotension and 30d outcomes, including the interaction with nesiritide.
Of 7,141 randomized patients, 1,555 (21.8%) had hypotension during hospitalization, with 27% symptomatic (median SBP 80mmHg, IQR 70-87), 73% asymptomatic (median SBP 83mmHg, IQR 79-88), and at median time 17.2h (IQR 5.2-30.8h). Table shows factors associated with hypotension. Nesiritide was used in 62.7% of patients experiencing hypotension and 46.4% of patients without hypotension. Hypotension was independently associated with 30d mortality (HR 2.16, p<0.001), but there was no interaction between nesiritide and hypotension on 30d mortality (p=0.26).
Hypotension is common during hospitalization for ADHF and is a major prognostic factor for 30d mortality independent of nesiritide therapy. Severity of heart failure and other factors contribute to risk of hypotension.
|Variable||Odds Ratio||Confidence Interval||p-value|
|Age (per year age >61 years)||1.01||1.00–1.02||0.003|
|Temperature (for each degree >36.4C)||1.40||1.13–1.74||0.002|
|SBP <= 127 (per each 1 mmHg increase)||0.96||0.95–0.97||<0.001|
|SBP >127 (per each 1 mmHg increase)||0.99||0.98–0.99||<0.001|
|Heart Rate <= 75 beats/minute||1.02||1.01–1.03||0.001|
|Baseline Sodium <=146||0.97||0.96–0.99||<0.001|
|Baseline Sodium >146||0.76||0.57–1.02||0.065|
|Baseline S3 gallop||1.24||1.08–1.42||0.003|
|Region (compared to North America)|
|Planned nesiritide therapy||2.08||1.84–2.35||<0.001|
Moderated Poster Contributions
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Acute Decompensated Heart Failure: Insights into Prognosis and Outcomes
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1172M-267
- 2013 American College of Cardiology Foundation