Hypotension During Hospitalization for Acute Heart Failure Is Independently Associated With 30-Day Mortality: Findings from ASCEND-HF. Circulation: Heart Failure, 2014. October 3, 2014. Priyesh A. Patel1, Gretchen Heizer1, Christopher M. O’Connor2, Phillip J. Schulte1, Kenneth Dickstein3, Justin A. Ezekowitz4,Paul W. Armstrong4, Vic Hasselblad1, Roger M. Mills5, John J. McMurray6,Randall C. Starling7, W. H. Wilson Tang7, Robert M. Califf2 and Adrian F. Hernandez2
1 Duke Clinical Research Institute, Durham, NC
2 Duke Clinical Research Institute, Durham, NC; Duke University Medical Center, Durham, NC
3 Stavanger University Hospital, Stavanger, Norway
4 Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada
5 Janssen Research and Development, LLC, Raritan, NJ
6 Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
7 Cleveland Clinic Foundation, Cleveland, OH
Background—Outcomes associated with episodes of hypotension while hospitalized are not well understood.
Methods and Results—Using data from 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, 1555/7141 (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 [OR] 1.98, 95% confidence interval [CI] 1.76-2.23; p<0.001), chronic metolazone therapy (OR 1.74, 95% CI 1.17-2.60; p<0.001), and baseline orthopnea (OR 1.31, 95% CI 1.13-1.52; p=0.001) or S3 gallop (OR 1.21, 95% CI 1.06-1.40; p=0.006). In-hospital hypotension was associated with increased hazards of 30-day mortality (hazard ratio [HR] 2.03, 95% CI 1.57-2.61; p<0.001), 30-day heart failure (HF) hospitalization or mortality (HR 1.58, 95% CI 1.34-1.86; p<0.001), and 30-day all-cause hospitalization or mortality (HR 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/HF hospitalization, p=0.238 death/all-cause hospitalization).
Conclusions—Hypotension while hospitalized for acute decompensated HF 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.