Division of Cardiology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico.
Duke Clinical Research Institute, Duke University, Durham, North Carolina.
JACC Heart Fail. 2016 Jan;4(1):42-9. doi: 10.1016/j.jchf.2015.09.012. Epub 2015 Dec 2.
This study assessed the association between pulse pressure (PP) and adverse outcomes at 1 year in patients hospitalized for heart failure (HF).
PP has been shown to be predictive of the development of HF. The value and utility of PP assessment in patients with prevalent HF is less clear.
We conducted a retrospective cohort study from clinical registry data linked to Medicare claims for 40,421 HF patients entered in the Get With the Guidelines-HF program. Cox proportional hazards models were used to estimate the association between discharge PP and all-cause mortality and the composite outcome of all-cause mortality/readmission by 1 year.
A nonlinear association between PP and mortality (expressed as hazard ratio [HR] per 10-mm Hg increase in PP) was observed in patients with HF and reduced (<0.40) ejection fraction (EF). Risk decreased as PP increased up to 50 mm Hg (adjusted HR: 0.946; 95% confidence interval [CI]: 0.900 to 0.995; p = 0.03). When PP was ≥50 mm Hg, risk increased as PP increased (adjusted HR: 1.091; 95% CI: 1.050 to 1.135; p < 0.001). In patients with HF and preserved EF (≥0.40), there was a significant association between PP and mortality with risk increasing as PP increased, although the magnitude of the risk was significantly impacted by systolic blood pressure (SBP). Qualitatively similar observations were obtained for the composite outcome and use of EF ≥0.50 to define HF with preserved EF.
The association between PP at hospital discharge and 1-year outcomes is a function of HF phenotype, SBP, and absolute PP.
本研究评估了心力衰竭（HF）住院患者出院时脉压（PP）与 1 年不良结局之间的关系。
已有研究表明 PP 可预测 HF 的发生。在患有 HF 的患者中，PP 评估的价值和实用性尚不清楚。
我们对来自临床注册数据的回顾性队列研究进行了分析，这些数据与 Medicare 索赔相关，纳入了 40421 例进入 Get With the Guidelines-HF 项目的 HF 患者。使用 Cox 比例风险模型估计出院时 PP 与全因死亡率以及 1 年内全因死亡率/再入院的复合结局之间的关系。
在射血分数（EF）降低（<0.40）的 HF 患者中，PP 与死亡率之间存在非线性关系（以每增加 10mmHg 的 HR 表示）。当 PP 增加到 50mmHg 时，风险会降低（校正 HR：0.946；95%置信区间：0.900 至 0.995；p=0.03）。当 PP≥50mmHg 时，随着 PP 的增加，风险会增加（校正 HR：1.091；95%置信区间：1.050 至 1.135；p<0.001）。在 EF≥0.40 的 HF 患者中，PP 与死亡率之间存在显著相关性，随着 PP 的增加，风险也会增加，尽管风险的幅度受到收缩压（SBP）的显著影响。使用 EF≥0.50 来定义 EF 保留型 HF 时，对复合结局和 SBP 也观察到了类似的结果。
出院时 PP 与 1 年结局之间的关系是 HF 表型、SBP 和绝对 PP 的函数。
