title: Combining heart rate and systolic blood pressure to improve risk stratification in older patients with heart failure: Findings from the RICA Registry.
abstract: OBJECTIVE
  Heart rate (HR) and systolic blood pressure (SBP) are independent prognostic variables in patients with heart failure (HF). We evaluated if combining HR and SBP could improve prognostic assessment in older patients.
  
  
  METHODS
  Variables associated with all-cause mortality and readmission for HF during 9months of follow-up were analyzed from the Spanish Heart Failure Registry (RICA). HR and SBP values were stratified in three combined groups.
  
  
  RESULTS
  We evaluated 1551 patients, 82years and 56% women. Using HR strata of <70 and ≥70bpm we found mortality rates of 9.8 and 13.6%, respectively (hazard ratio 1.0 and 1.35). For SBP≥140, 120-140 and <120mmHg, mortality rates were 8.2, 10.4 and 20.3%. respectively (hazard ratio 1.0, 1.34 and 2.76). Using combined strata of HR<70bpm and SBP≥140mmHg (n=176; low-risk), HR<70 and SBP<140+HR≥70 and SBP<120 (n=1089; moderate-risk) and HR≥70 and SBP<120 (n=286; high-risk) we found mortality rates of 4.5%, 11.0% and 24.0%, respectively. Multivariate Cox regression for all-cause mortality shows for low-, middle- and high-risk groups was 1 (reference), 1.93 (95% CI: 0.93-3.99, p=0.077) and 4.32 (95% CI: 2.04-9.14, p<0.001). BMI, NYHA, MDRD, hypertension and sodium were also independent prognostic factors.
  
  
  CONCLUSIONS
  The combination provides better risk discrimination than use of HR and SBP alone and may provide a simple and reliable tool for risk assessment for older HF patients in clinical practice.
authors.affiliation: Department of Internal Medicine, IMIBIC/Hospital Reina Sofía, University of Córdoba, Spain.
authors.forename: Justo
authors.initials: J
authors.lastname: Sánchez-Gil
authors.affiliation: Heart failure and Vascular Risk Unit, Department of Internal Medicine, Ramón y Cajal University Hospital, Universidad of Alcalá, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Manzano
authors.affiliation: Norwich Medical School, University of East Anglia and Norfolk and Norwich University Hospital, Norwich, UK.
authors.forename: Marcus
authors.initials: M
authors.lastname: Flather
authors.affiliation: Geriatric Unit, Department of Internal Medicine, IDIBELL, University Hospital of Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Formiga
authors.affiliation: Department of Internal Medicine, University Hospital Dr Negrín, Las Palmas, De Gran Canaria, Spain.
authors.forename: Alicia Conde
authors.initials: AC
authors.lastname: Martel
authors.affiliation: Department of Internal Medicine, Hospital of León, León, Spain.
authors.forename: Alberto Muela
authors.initials: AM
authors.lastname: Molinero
authors.affiliation: Department of Internal Medicine, Hospital Costa del Sol, Marbella, Spain.
authors.forename: Raul Quirós
authors.initials: RQ
authors.lastname: López
authors.affiliation: Department of Internal Medicine, University Hospital of Virgen Macarena, Sevilla, Spain.
authors.forename: Jose Luis Arias
authors.initials: JL
authors.lastname: Jiménez
authors.affiliation: Department of Internal Medicine, Hospital of Manises, Valencia, Spain.
authors.forename: Pau Llácer
authors.initials: PL
authors.lastname: Iborra
authors.affiliation: Department of Internal Medicine, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain.
authors.forename: Juan Ignacio
authors.initials: JI
authors.lastname: Perez-Calvo
authors.affiliation: Department of Internal Medicine, IMIBIC/Hospital Reina Sofía, University of Córdoba, Spain. Electronic address: fm1mopem@uco.es.
authors.forename: Manuel
authors.initials: M
authors.lastname: Montero-Pérez-Barquero
mesh_terms: D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000639:trends; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013599:Systole; D013997:Time Factors
keywords: Heart failure; Heart rate; Mortality; Prognosis; RICA registry; Systolic blood pressure