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Published on: June 12, 2021
Association Between Pressure-Adjusted Heart Rate and In-Hospital Mortality in Cardiogenic Shock
Curtis R Ginder1, Jacob C Jentzer2, Siddharth M Patel1
1Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Insights
Higher pressure-adjusted heart rate (PAHR) in cardiogenic shock (CS) patients is linked to increased in-hospital mortality. This simple hemodynamic index offers valuable prognostic insight for CS patients.
Area of Science:
- Cardiology
- Critical Care Medicine
- Hemodynamics
Background:
- Elevated right atrial pressure (RAP) and low mean arterial pressure (MAP) correlate with higher mortality in cardiogenic shock (CS).
- Pressure-adjusted heart rate (PAHR) integrates heart rate, RAP, and MAP, but its prognostic value in CS is unestablished.
Purpose of the Study:
- To determine if PAHR values are associated with the risk of in-hospital mortality among patients experiencing CS.
Main Methods:
- Utilized data from the Critical Care Cardiology Trials Network (CCCTN) registry (2018-2023).
- Analyzed 1411 CS admissions with invasive hemodynamic assessment within 24 hours of ICU admission, excluding those on mechanical support.
- Adjusted logistic regression models for age, sex, vasoactive-inotropic score, SCAI stage, and preceding cardiac arrest.
Main Results:
- A stepwise increase in in-hospital mortality was observed with higher presenting PAHR values.
- Higher PAHR was incrementally associated with increased in-hospital mortality (adjusted OR per 10 units: 1.35 [95% CI: 1.15-1.58]).
- PAHR demonstrated stronger prognostic associations with mortality compared to its individual hemodynamic components.
Conclusions:
- PAHR is a simple hemodynamic index derived from vital signs and central venous pressure.
- PAHR is strongly associated with in-hospital mortality in patients with cardiogenic shock.
Background:
Among patients with cardiogenic shock (CS), higher right atrial pressure (RAP) and lower mean arterial pressure (MAP) are associated with higher in-hospital mortality. Pressure-adjusted heart rate (PAHR), defined as heart rate × RAP/MAP, integrates these parameters. The prognostic significance of PAHR has not been assessed in patients with CS.
Objectives:
The authors aimed to assess if PAHR values are associated with risk of in-hospital mortality in patients with CS.
Methods:
CCCTN (Critical Care Cardiology Trials Network) is a multinational registry of cardiac intensive care units coordinated by the TIMI Study Group. Among CS admissions (2018-2023) undergoing invasive hemodynamic assessment within 24 hours of cardiac intensive care unit admission, we assessed the relationship of PAHR with in-hospital mortality. Patients with concurrent mechanical circulatory support were excluded in the primary analysis. ORs were adjusted for age, sex, vasoactive-inotropic score, Society for Cardiovascular Angiography and Interventions (SCAI) stage, and preceding cardiac arrest.
Results:
Among the 1411 CS admissions in the analysis (18% with acute myocardial infarction), 75% were receiving vasoactive support at the time of assessment. Median heart rate was 92 beats/min, RAP 15 mm Hg, MAP 75 mm Hg, and PAHR 17. There was a stepwise gradient of higher in-hospital mortality with higher presenting PAHR values. In adjusted models, a higher PAHR was incrementally associated with higher in-hospital mortality (adjusted OR per 10 units: 1.35 [95% CI: 1.15-1.58]), and PAHR had stronger prognostic associations with mortality than its individual hemodynamic components.
Conclusions:
PAHR, a simple hemodynamic index calculated from vital signs and central venous pressure, is strongly associated with in-hospital mortality in CS.
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