A Historical Perspective on Presentations of Hypertensive Acute Heart Failure.

Chad E Darling,David D Mcmanus,Darleen Lessard,Christopher W Baugh,Jiaoyuan Elisabeth Sun,Jordan Goldberg,Peter Pang

doi:10.4172/2329-9517.1000275

Abstract

BackgroundThe initial systolic blood pressure (SBP) in patients presenting to the hospital with acute heart failure (AHF) informs prognosis, diagnosis, and guides initial treatment. However, over time AHF presentations with elevated SBP appear to have declined. The present study examined whether the frequency of AHF presentations with systolic hypertension (SBP >160 mmHg) declined over a nearly two-decade time interval.MethodsThis study compares four historical, cross-sectional cohorts with AHF who were admitted to tertiary care medical centres in the North-eastern USA in 1995, 2000, 2006, and 2011–13. The main outcome was the proportion of AHF patients presenting with an initial SBP >160 mmHg.Results2,366 patients comprised the study sample. The average age was 77 years, 55% were female, 94% white, and 75% had prior heart failure. In 1995, 34% of AHF patients presented with an initial SBP >160 mmHg compared to 20% in 2011–2013 (p<0.01). Multivariate logistic regression demonstrated reduced odds of presenting with a SBP >160 mmHg in 2006 (0.64, 95% CI 0.42–0.96) and 2011–13 (0.46, 95% CI 0.28–0.74) compared with patients in 1995.ConclusionThe proportion of patients with AHF and initial SBP >160 mmHg significantly declined over the study time period. There are several potential reasons for this observation and these findings highlight the need for ongoing surveillance of patients with AHF as changing clinical characteristics can impact early treatment decisions.

Highlights

IntroductionOver 20 million people have chronic heart failure (HF) [1]. Patients with HF are prone to recurrent acute HF (AHF) exacerbations, and in the United States the majority of such patients are cared for in an emergency department (ED)
Worldwide, over 20 million people have chronic heart failure (HF) [1]
The proportion of patients with acute heart failure (AHF) and initial systolic blood pressure (SBP) >160 mmHg significantly declined over the study time period

Summary

Introduction

Over 20 million people have chronic heart failure (HF) [1]. Patients with HF are prone to recurrent acute HF (AHF) exacerbations, and in the United States the majority of such patients are cared for in an emergency department (ED). Several clinical parameters available at the time of hospital presentation, including history, exam, lab testing, xray, EKG, and point of care ultrasound, provide information that is useful in diagnosing the presence of AHF and guiding treatment [5]. Expert opinion has suggested that the initial, ED management of patients with AHF be based on the patient’s clinical profile [6]. This is, in part, influenced by vital signs at the time of presentation and in particular presenting blood pressure (BP) [7,8]. The initial systolic blood pressure (SBP) in patients presenting to the hospital with acute heart failure (AHF) informs prognosis, diagnosis, and guides initial treatment. The present study examined whether the frequency of AHF presentations with systolic hypertension (SBP >160 mmHg) declined over a nearly two-decade time interval

Methods

Results

Discussion

Conclusion