- 作者：Warren K. Laskey ; MD ; MPH&lowast ; ; wlaskey@salud.unm.edu" class="auth_mail" title="E-mail the corresponding author ; Jingjing Wu ; MS&dagger ; ; Phillip J. Schulte ; PhD&dagger ; ; Adrian F. Hernandez ; MD ; MHS&dagger ; ; Clyde W. Yancy ; MD ; MS&Dagger ; ; Paul A. Heidenreich ; MD ; MS§ ; ; Deepak L. Bhatt ; MD ; MPH‖ ; Gregg C. Fonarow ; MD¶ ;
- 关键词：heart failure ; pulse pressure
- 刊名：JACC: Heart Failure
- 出版年：2016
- 出版时间：January 2016
- 年：2016
- 卷：4
- 期：1
- 页码：42-49
- 全文大小：328 K
Background
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.
Methods
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.
Results
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.
Conclusions
The association between PP at hospital discharge and 1-year outcomes is a function of HF phenotype, SBP, and absolute PP.