Patients with heart failure and low systolic blood pressure at hospital admission are more likely to have poor outcomes including higher mortality rates and increased rates of rehospitalization, despite medical treatment, according to a study in the November 8 issue of JAMA.
Acute heart failure is a major public health concern because of its prevalence and associated illness and death. In 2003, 1.1 million patients were discharged from the hospital for heart failure, making this the most common discharge diagnosis among patients older than 65 years, according to background information in the article. Recent studies have indicated that the majority of patients hospitalized for heart failure are admitted with low or normal systolic blood pressure (SBP; the peak pressure in the arteries during the cardiac cycle). Elevated SBP may identify patients with certain clinical characteristics that are unique from those in patients with low SBP.
Mihai Gheorghiade, M.D., of the Feinberg School of Medicine, Northwestern University, Chicago, and colleagues evaluated the relationship between SBP at admission, patient clinical data, and outcomes in patients hospitalized for acute heart failure. The researchers analyzed data from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry and performance-improvement program, which included patients hospitalized with heart failure at 259 U.S. hospitals between March 2003 and December 2004. Patients were divided into quartiles by SBP at hospital admission (<120, 120-139, 140-161, and >161 mm Hg).
In-hospital outcomes were based on 48,612 patients age 18 years or older with heart failure. Of the 41,267 patients who had left ventricular function assessed, 21,149 (51 percent) had preserved left ventricular function. Outcomes following discharge from the hospital were based on a prespecified subgroup (n = 5,791, approximately 10 percent of patient
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