Abstract 12475: Risk Stratification with Control Status of Systolic Blood Pressure and Heart Rate in Patients with Chronic Heart Failure An Interim Analysis of the CHART-2 Study
Objectives: It is widely accepted that both increased heart rate (HR) and low systolic blood pressure (SBP) are significant predictors for mortality in heart failure (HF). However, it is often difficult to obtain optimal HR control in HF patients, especially in those with low SBP. Indeed, it is important to determine the priority rules and the target ranges of HR and SBP for the management of HF. In the present study, we thus aimed to stratify the mortality risk according to the control status of HR and SBP in HF patients registered in our Registry, named as the Chronic Heart Failure Analysis and Registry in the Tohoku District 2 (CHART-2) Study (NCT00418041, n=10,219).
Methods: From our Registry, we selected consecutive 2,858 stage C/D HF patients with sinus rhythm but without a documented history of atrial fibrillation (mean age 68.9 years, 69% male). We performed the classification and regression tree analysis for survival (survival CART).
Results: During a median follow-up period of 3.3 years, the incidence of all-cause death was 12.7%. The survival CART analysis initially identified HR, but not SBP, as the first discriminator with the split value of 70 bpm (15.9% vs. 9.3% in mortality rate for HR≥70 bpm and HR<70 bpm, respectively, hazard ratio 1.79, 95%CI, 1.44-2.21, P<0.001) (Figure). After the selection of the initial high risk population (HR≥70 bpm), the survival CART analysis identified SBP<115 mmHg as the second discriminator (mortality rate, 21.9% vs. 13.7% for SBP<115 mmHg and ≥115 mmHg, respectively, hazard ratio 1.77, 95%CI, 1.35-2.32, P<0.001). Finally, SBP<88 mmHg was identified as the third discriminator among the patients with HR≥70 bpm and SBP<115 mmHg (mortality rate, 50.0% vs. 21.0% for SBP<88 mmHg and ≥88 mmHg, respectively, hazard ratio 2.91, 95%CI, 1.34-6.32, P=0.007).
Conclusions: These results indicate that initial therapeutic target could be optimal HR control (<70 bpm), followed by BP control (≥115 mmHg), in patients with stage C/D HF and sinus rhythm.
- © 2012 by American Heart Association, Inc.