Prognostic implication of admission mean and pulse pressure in acute decompensated heart failure with different phenotypes


 
 
 It remains unknown whether admission mean (MAP) and pulse (PP) pressure are associated with short and longterm mortality in Chinese patients with heart failure with preserved (HFpEF), midrange (HFmrEF), and reduced (HFrEF) ejection fraction.
 
 
 
 In 2706 acute decompensated HF patients, we assessed the risk of 30day, 1 year, and longterm (>1 year) mortality with 1SD increment in MAP and PP, using multivariable logistic and Cox regression, respectively.
 
 
 
 During a median follow up of 4.1 years, 1341 patients died. The 30day, 1year, and longterm mortality were 3.5%, 16.7%, and 39.4%, respectively. A lower MAP was associated with higher risk of 30day mortality in women (P=0.023) and higher risk of 30day and 1year mortality in men (P≤0.006), while higher PP predicted longterm mortality in men (P≤0.014) with no relationship observed in women. In adjusted analyses additionally accounted for PP, 1SD increment in MAP was associated with 30day mortality in HFpEF (Odds ratio [OR], 0.63; 95% CI, 0.43-0.92; P=0.018), with 1year mortality in HFmrEF (OR, 0.46; 95% CI, 0.32-0.66; P<0.001) and HFrEF (OR, 0.54; 95% CI, 0.40-0.72; P<0.001). In adjusted model additionally accounted for MAP, 1-SD increment in PP was associated with longterm mortality in HFpEF (hazard ratio, 1.16; 95% CI, 1.05-1.28; P=0.003).
 
 
 
 A lower MAP was associated with higher risk of shortterm mortality in all HF subtypes, while a higher PP predicted higher risk of longterm mortality in men and in HFpEF. Our observations highlight the clinical importance of admission blood pressure for risk stratification in HF subtypes.
