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Title: Combining heart rate and systolic blood pressure to improve risk stratification in older patients with heart failure: Findings from the RICA Registry
Authors: Sánchez-Gil, Justo
Manzano, Luis
Flather, Marcus
Formiga, Francesc
Conde Martel, Alicia 
Molinero, Alberto Muela
López, Raul Quirós
Jiménez, Jose Luis Arias
Iborra, Pau Llácer
Perez-Calvo, Juan Ignacio
Montero-Pérez-Barquero, Manuel
UNESCO Clasification: 3205 Medicina interna
Keywords: Heart failure
Heart rate
RICA registry, et al
Issue Date: 2017
Journal: International Journal of Cardiology 
Abstract: Objectives 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. Methods Variables associated with all-cause mortality and readmission for HF during 9 months of follow-up were analyzed from the Spanish Heart Failure Registry (RICA). HR and SBP values were stratified in three combined groups. Results We evaluated 1551 patients, 82 years and 56% women. Using HR strata of < 70 and ≥ 70 bpm we found mortality rates of 9.8 and 13.6%, respectively (hazard ratio 1.0 and 1.35). For SBP ≥ 140, 120–140 and < 120 mm Hg, 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 < 70 bpm and SBP ≥ 140 mm Hg (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. Conclusions 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.
ISSN: 0167-5273
DOI: 10.1016/j.ijcard.2016.12.041
Source: International Journal of Cardiology [0167-5273], v. 230, p. 625-629
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