Acute hemodynamic index predicts in-hospital mortality in acute decompensated heart failure

Abstract

Background: The physical examination enables prognostic evaluation of patients with decompensated heart failure (HF), but lacks reliability and relies on the professional’s clinical experience. Considering hemodynamic responses to “fight or flight” situations, such as the moment of admission to the emergency room, we proposed the calculation of the acute hemodynamic index (AHI) from values of heart rate and pulse pressure. Objective: To evaluate the in-hospital prognostic ability of AHI in decompensated HF. Methods: A prospective, multicenter, registry-based observational study including data from the BREATHE registry, with information from public and private hospitals in Brazil. The prognostic ability of the AHI was tested by receiver-operating characteristic (ROC) analyses, C-statistics, Akaike’s information criteria, and multivariate regression analyses. p-values < 0.05 were considered statistically significant. Results: We analyzed data from 463 patients with heart failure with low ejection fraction. In-hospital mortality was 9%. The median AHI value was used as cut-off (4 mmHg⋅bpm). A low AHI (≤ 4 mmHg⋅bpm) was found in 80% of deceased patients. The risk of in-hospital mortality in patients with low AHI was 2.5 times that in patients with AHI > 4 mmHg⋅bpm. AHI independently predicted in-hospital mortality in acute decompensated HF (sensitivity: 0.786; specificity: 0.429; AUC: 0.607 [0.540–0.674]; p = 0.010) even after adjusting for comorbidities and medication use [OR: 0.061 (0.007– 0.114); p = 0.025). Conclusions: The AHI independently predicts in-hospital mortality in acute decompensated HF. This simple bed-side index could be useful in an emergency setting.