Predictors of Length of Hospital Stay And In-Hospital Adverse Events in Patients With Acute Decompensated Heart Failure: In-hospital 24-Hour Blood Pressure Monitoring Data

Abstract

Neurohumoral alterations in heart failure (HF) affect blood pressure variability (BPV) and vascular compliance, but little is known about this subject among patients admitted to hospital with decompensated HF. This study sought to investigate in-hospital 24-hour blood pressure monitoring (HBPM) derived BPV parameters and vascular compliance in patients with decompensated HF and to explore the association of these parameters with hospitalization length and in-hospital adverse events. A 24-hour blood pressure monitor was applied during the first 6 hours of admission to the hospital in patients with decompensated HF. Circadian patterns were determined by the study patients. Average real variability (ARV), pulse pressure index (PPI), pulse stiffening ratio (PSR), and ambulatory arterial stiffness index (AASI) values were calculated from HBPM recordings. Admission and discharge N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, length of hospitalization, and in-hospital adverse events were recorded. A total of 167 decompensated HF patients were included in the study. The dipper group exhibited a greater NT-proBNP decrease with the treatment compared to the non-dipper group and reverse dipper group. Hospitalization length was lower in the dipper group than in the non-dipper and reverse dipper groups. While ARV, AASI, and PSR were independently associated with the length of hospitalization, ARV, AASI, and PPI were independently associated with in-hospital adverse events. Post-admission HBPM-derived parameters (dipper pattern, ARV, PPI, PSR, AASI) of patients admitted to hospital with decompensated HF provide important prognostic information and predict the length of hospital stay.