A Simple Prognostic Index Based on Heart Rate, Age, and Systolic Blood Pressure for the Risk Stratification of Heart Failure With Preserved Ejection Fraction.

Abstract

Aim: A rapid and effective risk stratification method is highly important for the emergency care of patients with acute heart failure with preserved ejection fraction (HFpEF). Previous studies (including our own), have suggested that heart rate, age, and systolic blood pressure contribute to the pathophysiology of HFpEF. This study aimed to examine the predictive utility of the thrombolysis in myocardial infarction risk index (TRI)-consisting of heart rate, age, and systolic blood pressure-for determining the in-hospital mortality in patients with acute HFpEF.

Methods: This multicentre retrospective study included 7,040 consecutive patients with acute HFpEF. The TRI was calculated as TRI=(heart rate × age/10]²)/systolic blood pressure. Univariable and multivariable Cox regression analyses were used to identify the prognostic factors for in-hospital mortality. Receiver operating characteristic curve analysis was performed to evaluate the predictive ability of the TRI for in-hospital mortality.

Results: In-hospital mortality significantly increased from the low to the high quartile groups according to the TRIs. Univariable and multivariable Cox regression analyses identified the TRI as an independent prognostic factor for in-hospital mortality. The best cut-off TRI value was 35 and a TRI ≥35 had a sensitivity of 82%, specificity of 42%, positive predictive value of 66%, and negative predictive value of 98% for predicting in-hospital mortality.

Conclusion: The simple TRI tool is a significant predictor of in-hospital mortality of patients with acute HFpEF, suggesting that this rapid and straightforward risk stratification tool can be useful in daily clinical practice.