Bed-side inferior vena cava diameter and mean arterial pressure predict long-term mortality in hospitalized patients with heart failure: 36 months of follow-up

Abstract

BackgroundIn discharged patients with heart failure (HF), diverse conditions can intervene to worsen outcome. We would investigate whether such factors present on hospital admission can affect long-term mortality in subjects hospitalized for acute HF. MethodsOne hundred twenty-three consecutive patients hospitalized for acute HF (mean age 74.8years; 57% female) were recruited and followed for 36months after hospitalization. ResultsAt multivariate Cox model, only inferior vena cava (IVC) diameter and mean arterial pressure (MAP) registered bed-side on admission, resulted, after correction for all confounders factors, the sole factors significantly associated with a higher risk of all-cause mortality in long-term (HR 1.06, p=0.0057; HR 0.97, p=0.0218; respectively). Study population was subdivided according to median values of IVC diameter (23mm) and MAP (93.3mmHg). The Kaplan–Meier curve showed that HF patients with both IVC≥23mm and MAP <93.3mmHg on admission had reduced probability of survival free from all-cause death (log rank p=0.0070 and log rank p=0.0028, respectively). ConclusionsIn patients hospitalized for acute HF, IVC diameter, measured by hand-carried ultrasound (HCU), and MAP detected on admission are strong predictors of long-term all-cause mortality. The data suggest the need for a careful clinical-therapeutic surveillance on these patients during the post-discharge period. IVC diameter and MAP can be utilized as parameters to stratify prognosis on admission and to be supervised during follow-up.