Systolic Blood Pressure at Admission, Clinical Characteristics, and Outcomes in Patients Hospitalized With Acute Heart Failure

Gheorghiade, Mihai MD
Abraham, William T. MD
Albert, Nancy M. RN, PhD
Greenberg, Barry H. MD
O'Connor, Christopher M. MD
She, Lilin PhD
Stough, Wendy Gattis PharmD
Yancy, Clyde W. MD
Young, James B. MD
Fonarow, Gregg C. MD

Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill (Dr Gheorghiade); Division of Cardiology, Ohio State University, Columbus (Dr Abraham); George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, Ohio (Drs Albert and Young); Department of Medicine, University of California San Diego Medical Center, San Diego (Dr Greenberg); Duke Clinical Research Institute, Durham, NC (Drs O'Connor and She); Department of Medicine, Duke University Medical Center, Durham, NC (Dr Stough); Campbell University School of Pharmacy, Research Triangle Park, NC (Dr Stough); Department of Medicine, University of Texas Southwestern Medical Center, Dallas (Dr Yancy); and Department of Medicine, University of California Los Angeles Medical Center, Los Angeles (Dr Fonarow). Dr Yancy is now with the Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Tex.

Corresponding Author: Gregg C. Fonarow, MD, Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, 10833 LeConte Ave, Room 47–123 CHS, Los Angeles, CA 90095 ([email protected]).

Author Contributions: Drs Gheorghiade and Fonarow had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Gheorghiade, Abraham, Albert, Greenberg, O'Connor, Stough, Young, Fonarow.

Acquisition of data: Abraham, Albert, Greenberg, O'Connor, Young, Fonarow.

Analysis and interpretation of data: Gheorghiade, Abraham, Greenberg, O'Connor, She, Yancy, Young, Fonarow.

Drafting of the manuscript: Gheorghiade, Albert, Greenberg, O'Connor, She, Fonarow.

Critical revision of the manuscript for important intellectual content: Abraham, Greenberg, O'Connor, She, Yancy, Young, Fonarow.

Statistical analysis: She, Fonarow.

Obtained funding: Fonarow.

Administrative, technical, or material support: Greenberg, O'Connor, She.

Study supervision: Gheorghiade, Abraham, Greenberg, O'Connor, Fonarow.

Financial Disclosures: Dr Gheorghiade reported receiving research grants from the National Institutes of Health, Otsuka, Sigma Tau, Merck, and Scios Inc; being a consultant for Debbio Pharm, Errekappa Terapeutici, GlaxoSmithKline, Protein Design Labs, and Medtronic; and receiving honoraria from Abbott, AstraZeneca, GlaxoSmithKline, Medtronic, Otsuka, Protein Design Lab, Scios Inc, and Sigma Tau. Dr Abraham reported receiving research grants from Amgen, Biotronik, CHF Solutions, GlaxoSmithKline, Heart Failure Society of America, Medtronic, Myogen, the National Institutes of Health, Orqis Medical, Otsuka Maryland Research Institute, Paracor, and Scios Inc; being a consultant or serving on the speaker's bureau for Amgen, AstraZeneca, Boehringer-Ingelheim, CHF Solutions, GlaxoSmithKline, Guidant, Medtronic, Merck, Pfizer, ResMed, Respironics, Scios Inc, and St Jude Medical; being on the advisory board of CardioKine, CardioKinetix Inc, CHF Solutions, the Department of Veterans Affairs Cooperative Studies Program, Inovise, the National Institutes of Health, and Savacor Inc; and receiving honoraria from AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Guidant, Medtronic, Merck, Pfizer, ResMed, Respironics, Scios Inc, and St Jude Medical. Dr Albert reported being a consultant for GlaxoSmithKline and Medtronic; and serving on the speaker's bureau for GlaxoSmithKline, Medtronic, NitroMed, and Scios Inc. Dr Stough reported receiving research grants from Actelion, GlaxoSmithKline, Medtronic, Otsuka, and Pfizer; being a consultant or serving on the speaker's bureau for Abbott, AstraZeneca, GlaxoSmithKline, Medtronic, Novacardia, Otsuka, Protein Design Labs, RenaMed, Sigma Tau, and Scios Inc; and receiving honoraria from Abbott, AstraZeneca, GlaxoSmithKline, Medtronic, and Pfizer. Dr Greenberg reported receiving research grant support from Abbott Laboratories, Amgen, Cardiodynamics, GlaxoSmithKline, Medicines Company, Millennium, Novacardia, Otsuka, Pfizer, Sanofi-Aventis, and Titan; serving on the speaker's bureau or being a consultant for Amgen, AstraZeneca, GlaxoSmithKline, Guidant Corp, Medtronic, Merck & Co, NitroMed, Pfizer, Remon Medical Technologies, and Scios Inc; serving on the advisory board for CHF Solutions, GlaxoSmithKline, and NitroMed; and receiving honoraria from AstraZeneca, GlaxoSmithKline, Medtronic, Merck, NitroMed, Novartis, Pfizer, and Scios Inc. Dr O'Connor reported receiving research grant support from the National Institutes of Health; serving on the speaker's bureau and/or being a consultant for Amgen, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Guidant, Medtronic, Merck, NitroMed, Novartis, Otsuka, Pfizer, and Scios Inc; and receiving honoraria from GlaxoSmithKline, Pfizer, and Otsuka. Dr Yancy reported receiving research grants from Cardiodynamics, GlaxoSmithKline, Scios Inc, Medtronic, and NitroMed; being a consultant or serving on the speaker's bureau for AstraZeneca, Cardiodynamics, GlaxoSmithKline, Medtronic, NitroMed, Novartis, and Scios Inc; being on the advisory board for CHF Solutions, the Food and Drug Administration cardiovascular device panel, and the National Institutes of Health; and receiving honoraria from AstraZeneca, Cardiodynamics, GlaxoSmithKline, Medtronic, Novartis, and Scios Inc. Dr Young reported receiving research grants from Abbott, Acorn, Amgen, Artesion Therapeutics, AstraZeneca, Biosite, GlaxoSmithKline, Guidant, Medtronic, MicroMed, the National Institutes of Health, Scios Inc, Vasogen, and World Heart; and being a consultant for Abbott, Acorn, Amgen, Biomax Canada, Biosite, Boehringer-Ingelheim, Bristol-Myers Squibb, Cotherix, Edwards Lifescience, GlaxoSmithKline, Guidant, Medtronic, MicroMed, Novartis, Paracor, Proctor & Gamble, Protemix, Scios Inc, Sunshine, Thoratec, Transworld Medical Corp, Vasogen, Viacor, and World Heart. Dr Fonarow reported receiving research grants from Amgen, Biosite, Bristol-Myers Squibb, Boston Scientific/Guidant, GlaxoSmithKline, Medtronic, Merck, Pfizer, Sanofi-Aventis, Scios Inc, and the National Institutes of Health; serving on the speaker's bureau or receiving honoraria from Amgen, AstraZeneca, Biosite, Bristol-Myers Squibb, Boston Scientific/Guidant, GlaxoSmithKline, Kos, Medtronic, Merck, NitroMed, Pfizer, Sanofi-Aventis, Schering-Plough, Scios Inc, St Jude Medical, Takeda, and Wyeth; and being a consultant for Biosite, Bristol-Myers Squibb, Boston Scientific/Guidant, GlaxoSmithKline, Medtronic, Merck, NitroMed, Orqis Medical, Pfizer, Sanofi-Aventis, Schering-Plough, Scios Inc, and Wyeth.

Funding/Support: GlaxoSmithKline funded the OPTIMIZE-HF registry under the guidance of the OPTIMIZE-HF Steering Committee, the data collection and management by Outcome Inc, analysis of registry data at the Duke Clinical Research Institute, and administrative and material support by Accel Health.

Role of the Sponsor: GlaxoSmithKline was involved in the design and conduct of the OPTIMIZE-HF registry and funded data collection and management through Outcome Inc, and data management and statistical analyses through the Duke Clinical Research Institute. The sponsor was not involved in the management, analysis, or interpretation of data or the preparation of the manuscript. GlaxoSmithKline reviewed the manuscript prior to submission for publication.

JAMA: The Journal of the American Medical Association 296(18):p 2217-2226, November 8, 2006.

Context

The association between systolic blood pressure (SBP) at admission, clinical characteristics, and outcomes in patients hospitalized for heart failure who have reduced or relatively preserved systolic function has not been well studied.

Objective

To evaluate the relationship between SBP at admission, clinical profile, and outcomes in patients hospitalized for acute heart failure.

Design, Setting, and Patients

Cohort study using data from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry and performance-improvement program for patients hospitalized with heart failure at 259 US 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 aged 18 years or older with heart failure. Of the 41 267 patients with left ventricular function assessed, 21 149 (51%) had preserved left ventricular function. Postdischarge outcomes were based on a prespecified subgroup (n = 5791, 10% of patients) with follow-up data assessed between 60 and 90 days.

Main Outcome Measures

In-hospital and postdischarge mortality.

Results

Patients with higher SBP were more likely to be female and black and to have preserved systolic function. Fifty percent of the patients had SBP higher than 140 mm Hg at admission. Patients with lower SBP at admission had higher in-hospital and postdischarge mortality rates. Higher SBP at admission was associated with lower in-hospital mortality rates: 7.2% (<120 mm Hg), 3.6% (120–139 mm Hg), 2.5% (140–161 mm Hg), and 1.7% (>161 mm Hg) (P<.001 for overall difference). Postdischarge mortality rates in the follow-up cohort by SBP at admission were 14.0%, 8.4%, 6.0%, and 5.4%, respectively (P<.001 for overall difference).

Conclusions

Systolic hypertension is common in patients hospitalized for heart failure. Systolic blood pressure is an independent predictor of morbidity and mortality in patients with heart failure with either reduced or relatively preserved systolic function. Low SBP (<120 mm Hg) at hospital admission identifies patients who have a poor prognosis despite medical therapy. These findings may have important therapeutic implications because characteristics and outcomes differ greatly among patients with heart failure with varying SBP.