RISK STRATIFICATION AND MORTALITY OF ACUTE HEART FAILURE PATIENTS WITH HYPERTENSION AS UNDERLYING DISEASE

Purpose: To assess patients with anamnesis of hypertension (HT) hospitalised for
acute heart failure (AHF) and to determine their in-hospital (IHM) and one year mortality (1YM) rates and predictors of in-hospital mortality.
Methods: During the years 2005-2007 we hospitalised 1253 patients with AHF. We
selected 843 patients with anamnesis of HT (treated/ not treated) and analysed basic epidemiologic data and mortality rates. Univariate analysis was used to determine predictors of IHM.
Results: Mean age of HT patients was 72,3 years, 45,9% were female,
52,2% with new onset AHF. Main clinical manifestation was AHF with peripheral
oedema/congestion (48,6%) with the lowest IHM (1,5%), 12,8% of patients presented as cardiogenic shock with the highest IHM rate (87,0%). The most common aetiology of AHF were acute coronary syndromes (41,3%) and chronic coronary heart disease (21,5%). Median length of hospital stay was 7 days, overall IHM was 14%, 1YM rate reached 32,3%. IHM risk increased independently by age OR=1,28 (1,06-1,56), by elevated admission plasma creatinine level OR=1,29 (1,14-1,45), hyperglycaemia OR=2,75 (1,9-3,98), elevation of CRP OR=1,1 (1,07-1,13).
Blood pressure on admission (BP) lower than 120/80 strongly increased IHM by
OR=6,4 (4,22-9,7), also LV ejection fraction (EF) lower than 20% meant bad prognosis with OR=2,09 (1,03-4,21). When excluding patients with cardiogenic
shock (with extremely high IHM), AHF with peripheral oedema/congestion was associated with lower IHM rate (OR=0,23, 0,09-0,58), while right heart failure increased IHM of AHF patients with HT (OR=3,87, 1,09-13,95).
Conclusions: HT as underlying disease of AHF patients affects their outcome.
Especially cardiogenic shock of these patients is associated with very poor prognosis. Older age, renal impairment, hyperglycaemia, CRP elevation, BP<= 120/80 and low EF are increasing IHM.