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A. Basics
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C. Arrhythmias and Device Therapy
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
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15. Valvular Heart Disease
16. Infective Endocarditis
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
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ACUTE HEART FAILURE: PULSE PRESSURE AS A PREDICTOR OF HOSPITALIZATION AND MORTALITY
Session:
Painel 2 -Insuficiencia cardiaca 2
Speaker:
João Borges Rosa
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
João Borges Rosa; Patrícia M. Alves; Manuel Oliveira Santos; Gustavo M. Campos; Ana Vera Marinho; José Paulo Almeida; Tatiana Gonçalves; Rui Baptista; Isabel Fonseca; Lino Gonçalves
Abstract
<p>Introduction: Pulse pressure (PP) increases after the fifth decade of life. While before 50 years of age, women have a lower PP compared to men, the inverse usually occurs after 60 years of age. We aimed to evaluate whether PP at admission can be used as a prognostic marker in acute heart failure (AHF).</p> <p>Methods: We retrospectively studied 1026 patients admitted to our emergency department between November 2016 and December 2017 with a discharge diagnosis of AHF. PP was calculated as the difference between systolic and diastolic blood pressure (BP) at admission and the patients were divided into two groups (group “Low”: PP ≤40 mmHg and group “High”: PP >40 mmHg). Incidence of rehospitalization and cardiovascular (CV) or all-cause death was evaluated through multivariable logistic regression models and by Kaplan-Meyer survival curves.</p> <p>Results: Patients were followed up over a median period of 5 months (IQR 3-11 months). All patients had BP values at admission. Median age was 80 (IQR 18-99) years and 52.7% were male (n=541). Mean PP was 64.6 ± 24.0 mmHg, with 84.1% >40 mmHg and 15.9% ≤40 mmHg. In group “High” median age was higher (81 IQR 30-99 years vs. 77 IQR 18-96 years, p<0.01), proportion of males was lower (51.2% vs. 60.7%, p=0.03) and mean LVEF was higher (44 ± 12% vs. 35 ± 13%, p<0.01). The age-, sex-, and LVEF-adjusted odds ratio (OR) for hospitalization in group “Low” was 1.6 (95%CI 1.03-2.48, p=0.04) compared to group “High”, but the duration of hospitalization was similar (9 IQR 0-60 days vs. 9 IQR 1-89 days, p=0.65). There was no difference in the incidence of rehospitalization (23.2% vs. 29.1%, p<0.126). The age-, sex-, and LVEF-adjusted OR for CV death in group “Low” was 2.58 (95%CI 1.40-4.75, p<0.01) and for all-cause mortality 1.78 (95%CI 1.12-2.81, p=0.01), compared to group “High”. In women, the age-, and LVEF-adjusted OR for CV death in group “Low” was 5.21 (95%CI 2.17-12.54, p<0.01) and for all-cause mortality 2.40 (95%CI 1.16-4.96, p=0.02), while there was no difference among groups for men both for CV 1.52 (95%CI 0.64-3.65, p=0.34) and all-cause mortality 1.49 (95%CI 0.82-2.69, p=0.19). Kaplan-Meier estimates of CV mortality during follow-up by gender are shown in Figure 1.</p> <p>Conclusions: PP ≤40 mmHg at admission predicts hospitalization, CV and all-cause death in patients with acute heart failure. Whether this feature is only valid for females needs to be ascertained by other studies.</p>
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