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Pulmonary hypertension predicts all‐cause mortality in patients with heart failure: a retrospective cohort study
Author(s) -
Szwejkowski Benjamin R.,
Elder Douglas H.J.,
Shearer Fiona,
Jack David,
Choy Anna Maria J.,
Pringle Stuart D.,
Struthers Allan D.,
George Jacob,
Lang Chim C.
Publication year - 2012
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfr159
Subject(s) - medicine , heart failure , pulmonary hypertension , cardiology , hazard ratio , proportional hazards model , cohort , retrospective cohort study , cohort study , population , confidence interval , environmental health
Aims The presence of pulmonary hypertension (PH) in left ventricular systolic dysfunction (LVSD) and symptomatic heart failure is an ominous sign. There are insufficient data regarding the risk conferred by increasing severity of PH in patients with heart failure. Methods and results We performed a record linkage study in Tayside, Scotland (population ∼400 000) utilizing the Tayside echocardiogram database (>50 000 echocardiograms) maintained by the Health Informatics Centre (HIC). Data sets from the HIC include mortality data, cardiovascular medications, and other healthcare activities linked anonymously by the community health index (CHI) number. Patients were included in the analysis if they had LVSD, had a valid right ventricular systolic pressure (RVSP) measurement, and had a loop diuretic prescription (provided not more than 1 year prior to echocardiogram). A Cox proportional hazard model was used to examine the effects of RVSP on all‐cause mortality. A total of 1612 patients [mean age, 75.2 ± 10.9 (SD) years; 57.4% male] met the entry criteria. Mean RVSP for the cohort was 44.9 ± 13.1 mmHg and mean follow‐up was 2.8 ± 2.5 years. For each 5 mmHg stepwise increase in RVSP, after adjustment for confounding factors including the degree of LVSD and the presence of chronic obstructive pulmonary disease, the hazard ratio (HR) for all‐cause mortality was 1.06 (1.03–1.08, P < 0.001). Conclusions Pulmonary hypertension predicted all‐cause mortality in a heterogeneous group of patients with heart failure. Each 5 mmHg rise in RVSP was associated with a 6% increased risk of death.