Sánchez-Gil Justo, Manzano Luis, Flather Marcus, Formiga Francesc, Martel Alicia Conde, Molinero Alberto Muela, López Raul Quirós, Jiménez Jose Luis Arias, Iborra Pau Llácer, Perez-Calvo Juan Ignacio, Montero-Pérez-Barquero Manuel
Department of Internal Medicine, IMIBIC/Hospital Reina Sofía, University of Córdoba, Spain.
Heart failure and Vascular Risk Unit, Department of Internal Medicine, Ramón y Cajal University Hospital, Universidad of Alcalá, Madrid, Spain.
Int J Cardiol. 2017 Mar 1;230:625-629. doi: 10.1016/j.ijcard.2016.12.041. Epub 2016 Dec 27.
Heart rate (HR) and systolic blood pressure (SBP) are independent prognostic variables in patients with heart failure (HF). We evaluated if combining HR and SBP could improve prognostic assessment in older patients.
Variables associated with all-cause mortality and readmission for HF during 9months of follow-up were analyzed from the Spanish Heart Failure Registry (RICA). HR and SBP values were stratified in three combined groups.
We evaluated 1551 patients, 82years and 56% women. Using HR strata of <70 and ≥70bpm we found mortality rates of 9.8 and 13.6%, respectively (hazard ratio 1.0 and 1.35). For SBP≥140, 120-140 and <120mmHg, mortality rates were 8.2, 10.4 and 20.3%. respectively (hazard ratio 1.0, 1.34 and 2.76). Using combined strata of HR<70bpm and SBP≥140mmHg (n=176; low-risk), HR<70 and SBP<140+HR≥70 and SBP<120 (n=1089; moderate-risk) and HR≥70 and SBP<120 (n=286; high-risk) we found mortality rates of 4.5%, 11.0% and 24.0%, respectively. Multivariate Cox regression for all-cause mortality shows for low-, middle- and high-risk groups was 1 (reference), 1.93 (95% CI: 0.93-3.99, p=0.077) and 4.32 (95% CI: 2.04-9.14, p<0.001). BMI, NYHA, MDRD, hypertension and sodium were also independent prognostic factors.
The combination provides better risk discrimination than use of HR and SBP alone and may provide a simple and reliable tool for risk assessment for older HF patients in clinical practice.
心率（HR）和收缩压（SBP）是心力衰竭（HF）患者的独立预后变量。我们评估了将HR和SBP相结合是否能改善老年患者的预后评估。
从西班牙心力衰竭注册研究（RICA）中分析随访9个月期间与全因死亡率和HF再入院相关的变量。HR和SBP值被分为三个组合组。
我们评估了1551例患者，年龄82岁，女性占56%。使用HR分层<70和≥70次/分钟，我们发现死亡率分别为9.8%和13.6%（风险比1.0和1.35）。对于SBP≥140、120 - 140和<120mmHg，死亡率分别为8.2%、10.4%和20.3%（风险比1.0、1.34和2.76）。使用HR<70次/分钟且SBP≥140mmHg（n = 176；低风险）、HR<70且SBP<140 + HR≥70且SBP<120（n = 1089；中度风险）和HR≥70且SBP<120（n = 286；高风险）的组合分层，我们发现死亡率分别为4.5%、11.0%和24.0%。全因死亡率的多变量Cox回归显示，低、中、高风险组分别为1（参考值）、1.93（95%CI：0.93 - 3.99，p = 0.077）和4.32（95%CI：2.04 - 9.14，p<0.001）。BMI、纽约心脏协会（NYHA）分级、肾脏病饮食改良试验（MDRD）、高血压和钠也是独立的预后因素。
这种组合比单独使用HR和SBP能提供更好的风险区分，并且可能为临床实践中评估老年HF患者的风险提供一种简单可靠的工具。
