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New study identifies systolic blood pressure as a key vital sign in heart failure patients

03/01/2007

New research indicates that heart failure patients with higher systolic blood pressure have substantially lower death rates compared to those with lower systolic pressures. In addition, lower systolic pressures may indicate more advanced heart disease and a poorer prognosis. The findings may help clinicians more effectively assess risk and offer more targeted treatments.

Systolic blood pressure signifies the maximum arterial pressure during contraction of the left ventricle of the heart — typically the first number in a blood pressure reading (for example, 120 mm Hg when the blood pressure is reported as 120/80 mm Hg — measured in millimeters of mercury).

The study revealed the following in-hospital mortality rates by systolic blood pressure levels: 7.2 percent mortality rate for patients with low systolic pressures of less than 120 mm Hg.; 3.6 percent mortality rate for patients with pressures between 120 and 139 mm Hg (generally considered in the normal range); 2.5 percent for patients with higher systolic pressures between 140-161 mm Hg; and 1.7 percent mortality rate for patients with very high systolic pressures over 161 mm Hg.

Gregg Fonarow, M.D., director of the Ahmanson-UCLA Cardiomyopathy Center, is one of the authors of the study, which was published in the Nov. 8, 2006, issue of the Journal of the American Medical Association. It is the first study to use patient data from a large heart-failure-patient registry called the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure. The registry includes information on 48,612 heart failure patients seen at 259 U.S. hospitals between March 2003 and December 2004.

Heart Failure

Heart failure occurs when the heart is not working effectively. One cause of heart failure is the inability of the heart’s left ventricle to pump enough blood to the body’s other organs. The disease affects nearly 5 million Americans, killing about 250,000 annually. An estimated $8 billion to $15 billion is spent each year on heart failure inpatient care, twice the amount spent on all forms of cancer combined. As more patients survive myocardial infarction but are left with reduced ventricular function, heart failure is the only major cardiovascular disease still increasing in incidence.

Ahmanson-UCLA Cardiomyopathy Center

The multidisciplinary Ahmanson-UCLA Cardiomyopathy Center has led efforts to manage heart failure since opening in 1984. Its recent scientific research and clinical trials have identified medical therapies, devices and disease management strategies that can offer patients markedly improved quality of life, reduced risk of hospitalization and improve survival.

Patients range from those with risk factors or asymptomatic disease to those with advanced heart failure requiring evaluation for heart transplantation. The center offers a full range of diagnostic and treatment alternatives, including cardiac transplantation, bridging mechanical assist devices, and cardiac resynchronization therapy in addition to comprehensive heart failure disease management and risk assessment.

The center encompasses the outpatient Heart Failure Clinic, the inpatient Advanced Cardiac Evaluation (ACE) Unit, the Exercise Laboratory, the UCLA Cardiac Arrhythmia Center and the Cardiac Transplantation Clinic, and is closely affiliated with the UCLA Cardiothoracic Surgery Service.

Ahmanson-UCLA Cardiomyopathy Center physicians

Gregg C. Fonarow, M.D.
Director, Ahmanson-UCLA Cardiomyopathy Center

Michele Hamilton, M.D.
Co-Director, Heart Failure Program

Jaime Moriguchi, M.D.
Co-Director, Heart Failure Program

Jon A. Kobashigawa, M.D.
Medical Director, Adult Heart Transplant Program

Daniel Cruz, M.D.
Cardiomyopathy Consultant

Antoine Hage, M.D.
Cardiomyopathy Consultant

Tamara Horwich, M.D.
Cardiomyopathy Consultant

Allison Kean, M.D.
Cardiomyopathy Consultant

Michelle Kittleson, M.D.
Cardiomyopathy Consultant

Robb MacLellan, M.D.
Cardiomyopathy Consultant

Jignesh Patel, M.D., Ph.D.
Cardiomyopathy Consultant

Revelant publication

Systolic Blood Pressure at Admission, Clinical Characteristics, and Outcomes in Patients Hospitalized With Acute Heart Failure. Mihai Gheorghiade; William T. Abraham; Nancy M. Albert; Barry H. Greenberg; Christopher M. O’Connor; Lilin She; Wendy Gattis Stough; Clyde W. Yancy; James B. Young; Gregg C. Fonarow; for the OPTIMIZE-HF Investigators and Coordinators. JAMA. 2006;296:2217-2226.

Patient referral

Physicians may refer patients to the Ahmanson-UCLA Cardiomyopathy Center by calling (310) 825-8816. Patients with advanced heart failure that are unstable or unable to be discharged from the hospital may be transferred to UCLA Medical Center on an urgent basis at any time by calling (310) 825-6068.

For more information, please visit our website at http://www.chf.mednet.ucla.edu/





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