Synergistic Impact of Systolic Blood Pressure and Perfusion Status on Mortality in Acute Heart Failure

Background: Physical examination remains the cornerstone in assessment of acute heart failure. There is a lack adequately powered studies assessing combined impact both systolic blood pressure (SBP) and hypoperfusion on short-term mortality. Methods: Patients with failure from 41 Spanish emergency departments were recruited consecutively 3 time periods between 2011 2016. Logistic regression models used to assess association 30-day mortality SBP (<90, 90–109, 110–129, ?130 mm Hg) manifestations (cold skin, cutaneous pallor, delayed capillary refill, livedo reticularis, mental confusion) at admission. Results: Among 10 979 patients, 1143 died within first 30 days (10.2%). was an inverse initial (35.4%, 18.9%, 12.4%, 7.5% for SBP<90, SBP?130 Hg, respectively; P <0.001) positive (8.0%, 14.8%, 27.6% those none, 1, ?2 signs/symptoms hypoperfusion, <0.001). After adjustment 11 risk factors, prognostic varied across categories: Hg (odds ratio [OR]=1.03 [95% CI, 0.77–1.36] OR=1.18 0.86–1.62] 1 compared 0 hypoperfusion), 110 129 (OR=1.23 0.86–1.77] OR=2.18 1.44–3.31], respectively), 90 109 (OR=1.29 0.79–2.10] OR=2.24 1.36–3.66], SBP<90 (OR=1.34 0.45–4.01] OR=3.22 1.30–7.97], respectively); -for-interaction =0.043. Conclusions: Hypoperfusion confers incremental all-cause not only patients low but also normotensive patients. On admission, physical plays major role determining prognosis