Heart Rate and Mortality in Patients With Acute Symptomatic Pulmonary Embolism.
Por:
Jaureguízar A, Jiménez D, Bikdeli B, Ruiz-Artacho P, Muriel A, Tapson V, López-Reyes R, Valero B, Kenet G and Monreal M
Publicada:
1 feb 2022
Ahead of Print:
31 ago 2021
Resumen:
BACKGROUND: The association between heart rate (HR) and pulmonary embolism (PE) outcomes has not been well studied. Furthermore, optimal cutoffs to identify low-risk and intermediate- to high-risk patients are not well known. RESEARCH QUESTION: Does an association exist between baseline HR and PE outcome across the continuum of HR values? STUDY DESIGN AND METHODS: The current study included 44,331 consecutive nonhypotensive patients with symptomatic PE from the Registro Informatizado de la Enfermedad TromboEmbólica registry between 2001 and 2021. Outcomes included 30-day all-cause and PE-specific mortality. We used hierarchical logistic regression to assess the association between admission HR and outcomes. RESULTS: A positive relationship was found between admission HR and 30-day all-cause and PE-related mortality. Considering an HR of 80 to 99 beats/min as a reference, patients in the higher HR strata showed higher rates of all-cause death (adjusted OR, 1.5 for HR of 100-109 beats/min; adjusted OR, 1.7 for HR of 110-119 beats/min; adjusted OR, 1.9 for HR of 120-139 beats/min; and adjusted OR, 2.4 for HR of = 140 beats/min). Patients in the lower strata of HR showed significantly lower rates of 30-day all-cause mortality compared with the same reference group (adjusted OR, 0.6 for HR of 60-79 beats/min; and adjusted OR, 0.5 for HR of < 60 beats/min). The findings for 30-day PE-related mortality were similar. For identification of low-risk patients, a cutoff value of 80 beats/min (vs 110 beats/min) increased the sensitivity of the simplified Pulmonary Embolism Severity Index (sPESI) from 93.4% to 98.8%. For identification of intermediate- to high-risk patients, a cutoff value of 140 beats/min (vs 110 beats/min) increased the specificity of the Bova score from 93.2% to 98.0%. INTERPRETATION: In nonhypotensive patients with acute symptomatic PE, a high HR portends an increased risk of all-cause and PE-related mortality. Modifying the HR cutoff in the sPESI and the Bova score improves prognostication of patients with PE.
Filiaciones:
Jaureguízar A:
Respiratory Department, Hospital Ramón y Cajal and Universidad de Alcalá (IRYCIS), Madrid, Spain
Jiménez D:
Respiratory Department, Hospital Ramón y Cajal and Universidad de Alcalá (IRYCIS), Madrid, Spain
CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
Bikdeli B:
Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
Center for Outcomes Research and Evaluation (CORE), Yale School of Medicine, New Haven, CT
Clinical Trials Center, Cardiovascular Research Foundation, New York, NY
Ruiz-Artacho P:
CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
Department of Internal Medicine, Clínica Universidad de Navarra, Madrid, Spain
Interdisciplinar Teragnosis and Radiosomics Research Group, Universidad de Navarra, Madrid, Spain
Muriel A:
Department of Biostatistics, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBERESP, Madrid, Spain
Tapson V:
Pulmonary and Critical Care Division, Cedars-Sinai Medical Center, Los Angeles, CA
López-Reyes R:
Department of Pneumology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
Valero B:
Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante, Spain
Kenet G:
Department of Pediatric Hemato-Oncology, Sheba Medical Center, Ramat Gan, Israel
:
CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona
Universidad Católica de Murcia, Murcia, Spain
|