Rapid Clinical Assessment of Patients with Acute Heart Failure: First Blood Pressure and Oxygen Saturation – Is That All We Need?

Abstract

The risk stratification of patients with acute heart failure (AHF) has been addressed repeatedly in recent years. Low oxygen saturation (SaO₂) and systolic blood pressure (SBP) are signs of impending respiratory and circulatory failure that can be obtained quickly in patients with AHF. Methods: Admissions for AHF (340 patients) in a city hospital were recorded and patients were followed for symptoms of heart failure, re-admission and mortality for 6 months. Results: Patients with low (<90%) SaO₂ had higher rates of worsening heart failure at 1 month and 6 months (p < 0.001 and p < 0.001, respectively) and higher rates of mortality (p = 0.013). SBP <120 mm Hg was not associated with a significant increase in worsening heart failure, but was associated with a statistically significant increase in mortality at 1 and 6 months (p < 0.001 and p < 0.001, respectively). Combined low SaO₂ and SBP had a particularly strong prognostic implication. Patients who developed frank respiratory failure and/or circulatory failure fared the worst. Patients requiring ventilatory support had a recurrent heart failure rate of 81% and a mortality of 41% at 1 month of follow-up. Patients requiring intravenous pressors without respiratory mechanical support had a recurrent heart failure rate of 72% and a mortality rate of 28% at 1 month (p < 0.001). Conclusions: Simple assessment of impending respiratory and circulatory failure at admission by measuring SaO₂ and SBP enables rapid and accurate risk stratification of patients admitted for AHF. This may enable more aggressive therapeutic interventions for stabilization and treatment of AHF.

Improving care for patients with acute heart failure: before, during and after hospitalization

“…a heart attack) showed a significant increase in riskadjusted death rate. 102 Several models for risk stratification have been proposed, ranging from schemes based on a few assessments (such as admission SBP and oxygen saturation, 103 age and renal function, 104 or SBP and renal function 105 ) to complex models involving multiple factors. The aim of this socalled 'risk stratification' is to manage patients more effectively, directing resources to those who need them most.…”

Blood gas analysis of the coronary sinus in patients with heart failure

“…Previous studies have suggested that arterial SO 2 is associated with mortality and rehospitalization, and has prognostic implications for patients with HF (11,12). These studies demonstrated that lower arterial SO 2 indicates a worse prognosis.…”

Variability in use of IV nitrates and diuretics in acute HF: a ‘virtual patient’ clinical decision-making study

“…100,101 Alternatively, it could help to identify high-risk patients who would benefit from close follow-up after discharge. 102 Several models for risk stratification have been proposed, ranging from schemes based on a few assessments (such as admission SBP and oxygen saturation, 103 age and renal function, 104 or SBP and renal function 105 ) to complex models involving multiple factors. 102,106 However, none of these is sufficiently well developed for widespread adoption, mainly because of the variation in presentation and underlying causes of acute heart failure.…”