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.
Heart Rate and Mortality in Patients With Acute Symptomatic Pulmonary Embolism / Jaureguizar, A.; Jimenez, D.; Bikdeli, B.; Ruiz-Artacho, P.; Muriel, A.; Tapson, V.; Lopez-Reyes, R.; Valero, B.; Kenet, G.; Monreal, M.; Prandoni, P.; Brenner, B.; Farge-Bancel, D.; Barba, R.; Di Micco, P.; Bertoletti, L.; Schellong, S.; Tzoran, I.; Reis, A.; Bosevski, M.; Bounameaux, H.; Maly, R.; Verhamme, P.; Caprini, J. A.; Bui, H. M.; Adarraga, M. D.; Aibar, J.; Aibar, M. A.; Alonso, J.; Amado, C.; Arcelus, J. I.; Asuero, A.; Azcarate-Aguero, P.; Ballaz, A.; Barba, R.; Barbagelata, C.; Barron, M.; Barron-Andres, B.; Blanco-Molina, A.; Beddar Chaib, F.; Camon, A. M.; Castro, J.; Chasco, L.; Criado, J.; de Ancos, C.; del Toro, J.; Demelo-Rodriguez, P.; Diaz-Brasero, A. M.; Diaz-Pedroche, M. C.; Diaz-Peromingo, J. A.; Di Campli, M. V.; Dubois-Silva, A.; Escribano, J. C.; Esposito, F.; Farfan-Sedano, A. I.; Fernandez-Capitan, C.; Fernandez-Reyes, J. L.; Fidalgo, M. A.; Flores, K.; Font, C.; Font, L.; Francisco, I.; Gabara, C.; Galeano-Valle, F.; Garcia, M. A.; Garcia-Bragado, F.; Garcia de Herreros, M.; Garcia de la Garza, R.; Garcia-Diaz, C.; Gil-Diaz, A.; Gomez-Cuervo, C.; Gimenez-Suau, M.; Grau, E.; Guirado, L.; Gutierrez, J.; Hernandez-Blasco, L.; Jara-Palomares, L.; Jaras, M. J.; Jimenez, D.; Jimenez-Alfaro, C.; Joya, M. D.; Lainez-Justo, S.; Latorre, A.; Lima, J.; Lobo, J. L.; Lopez-Jimenez, L.; Lopez-Miguel, P.; Lopez-Nunez, J. J.; Lopez-Reyes, R.; Lopez-Saez, J. B.; Lorenzo, A.; Madridano, O.; Maestre, A.; Marchena, P. J.; Martin del Pozo, M.; Martin-Martos, F.; Martinez-Urbistondo, D.; Mella, C.; Mercado, M. I.; Moises, J.; Monreal, M.; Munoz, M.; Munoz-Blanco, A.; Nieto, J. A.; Nofuentes-Perez, E.; Nunez-Fernandez, M. J.; Olid-Velilla, M.; Olivares, M. C.; Osorio, J.; Otalora, S.; Otero, R.; Pedrajas, J. M.; Pellejero, G.; Porras, J. A.; Portillo, J.; Rodriguez-Matute, C.; Rosa, V.; Ruiz-Artacho, P.; Ruiz-Ruiz, J.; Salgueiro, G.; Sanchez-Martinez, R.; Sanchez-Munoz-Torrero, J. F.; Sancho, T.; Soler, S.; Suarez-Rodriguez, B.; Surinach, J. M.; Torres, M. I.; Tolosa, C.; Trujillo-Santos, J.; Uresandi, F.; Valero, B.; Valle, R.; Varona, J. F.; Vela, L.; Vela, J. R.; Vidal, G.; Villalobos, A.; Villares, P.; Zamora, C.; Ay, C.; Nopp, S.; Pabinger, I.; Vanassche, T.; Vandenbriele, C.; Verhamme, P.; Hirmerova, J.; Maly, R.; Accassat, S.; Ait Abdallah, N.; Bertoletti, L.; Bura-Riviere, A.; Catella, J.; Couturaud, F.; Crichi, B.; Debourdeau, P.; Espitia, O.; Farge-Bancel, D.; Grange, C.; Helfer, H.; Lacut, K.; Le Mao, R.; Mahe, I.; Morange, P.; Moustafa, F.; Poenou, G.; Sarlon-Bartoli, G.; Suchon, P.; Quere, I.; Schellong, S.; Braester, A.; Brenner, B.; Kenet, G.; Tzoran, I.; Basaglia, M.; Bilora, F.; Bortoluzzi, C.; Brandolin, B.; Ciammaichella, M.; De Angelis, A.; Di Micco, P.; Imbalzano, E.; Merla, S.; Pesavento, R.; Prandoni, P.; Siniscalchi, C.; Tufano, A.; Visona, A.; Vo Hong, N.; Zalunardo, B.; Nishimoto, Y.; Sato, Y.; Birzulis, J.; Skride, A.; Zaicenko, A.; Fonseca, S.; Martins, F.; Meireles, J.; Bosevski, M.; Krstevski, G.; Bounameaux, H.; Mazzolai, L.; Bikdeli, B.; Caprini, J. A.; Bui, H. M.. - In: CHEST. - ISSN 0012-3692. - 161:2(2022), pp. 524-534. [10.1016/j.chest.2021.08.059]
Heart Rate and Mortality in Patients With Acute Symptomatic Pulmonary Embolism
Di Micco P.;Tufano A.;
2022
Abstract
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
