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

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

Research output: Contribution to journalArticle

22 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)918-925
Number of pages8
JournalCirculation: Heart Failure
Volume7
Issue number6
DOIs
StatePublished - Nov 1 2014
Externally publishedYes

Fingerprint

Brain Natriuretic Peptide
Hypotension
Hospitalization
Heart Failure
Mortality
Confidence Intervals
Odds Ratio
Metolazone
Random Allocation
Proportional Hazards Models
Cause of Death
Therapeutics
Logistic Models
Clinical Trials
Kidney

Keywords

  • Brain
  • Heart failure
  • Hypotension
  • Natriuretic peptide

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Hypotension during hospitalization for acute heart failure is independently associated with 30-day mortality findings from ASCEND-HF. / Patel, Priyesh A.; Heizer, Gretchen; O'Connor, Christopher M.; Schulte, Phillip; Dickstein, Kenneth; Ezekowitz, Justin A.; Armstrong, Paul W.; Hasselblad, Vic; Mills, Roger M.; McMurray, John J V; Starling, Randall C.; Tang, W. H Wilson; Califf, Robert M.; Hernandez, Adrian F.

In: Circulation: Heart Failure, Vol. 7, No. 6, 01.11.2014, p. 918-925.

Research output: Contribution to journalArticle

Patel, PA, Heizer, G, O'Connor, CM, Schulte, P, Dickstein, K, Ezekowitz, JA, Armstrong, PW, Hasselblad, V, Mills, RM, McMurray, JJV, Starling, RC, Tang, WHW, Califf, RM & Hernandez, AF 2014, 'Hypotension during hospitalization for acute heart failure is independently associated with 30-day mortality findings from ASCEND-HF', Circulation: Heart Failure, vol. 7, no. 6, pp. 918-925. https://doi.org/10.1161/CIRCHEARTFAILURE.113.000872
Patel, Priyesh A. ; Heizer, Gretchen ; O'Connor, Christopher M. ; Schulte, Phillip ; Dickstein, Kenneth ; Ezekowitz, Justin A. ; Armstrong, Paul W. ; Hasselblad, Vic ; Mills, Roger M. ; McMurray, John J V ; Starling, Randall C. ; Tang, W. H Wilson ; Califf, Robert M. ; Hernandez, Adrian F. / Hypotension during hospitalization for acute heart failure is independently associated with 30-day mortality findings from ASCEND-HF. In: Circulation: Heart Failure. 2014 ; Vol. 7, No. 6. pp. 918-925.
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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.",
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TY - JOUR

T1 - Hypotension during hospitalization for acute heart failure is independently associated with 30-day mortality findings from ASCEND-HF

AU - Patel, Priyesh A.

AU - Heizer, Gretchen

AU - O'Connor, Christopher M.

AU - Schulte, Phillip

AU - Dickstein, Kenneth

AU - Ezekowitz, Justin A.

AU - Armstrong, Paul W.

AU - Hasselblad, Vic

AU - Mills, Roger M.

AU - McMurray, John J V

AU - Starling, Randall C.

AU - Tang, W. H Wilson

AU - Califf, Robert M.

AU - Hernandez, Adrian F.

PY - 2014/11/1

Y1 - 2014/11/1

N2 - 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.

AB - 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.

KW - Brain

KW - Heart failure

KW - Hypotension

KW - Natriuretic peptide

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