Modified reverse shock index predicts early outcomes of heart failure with reduced ejection fraction

Gyu Chul Oh, Seokyung An, Hae Young Lee, Hyun Jai Cho, Eun Seok Jeon, Sang Eun Lee, Jae Joong Kim, Seok Min Kang, Kyung Kuk Hwang, Myeong Chan Cho, Shung Chull Chae, Dong Ju Choi, Byung Su Yoo, Kye Hun Kim, Sue K. Park, Sang Hong Baek

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

Aims: Increased blood pressure (BP) and decreased heart rate (HR) are signs of stabilization in patients admitted for acute HF. Changes in BP and HR during admission and their correlation with outcomes were assessed in hospitalized patients with heart failure (HF) with reduced ejection fraction (HFrEF). Methods: A novel modified reverse shock index (mRSI), defined as the ratio between changes in systolic BP and HR during admission, was devised, and its prognostic value in the early outcomes of acute HF was assessed using the Korean Acute HF registry. Results: Among 2697 patients with HFrEF (mean age 65.8 ± 14.9 years, 60.6% males), patients with mRSI ≥1.25 at discharge were significantly younger and were more likely to have de novo HF. An mRSI ≥1.25 was associated with a significantly lower incidence of 60-day and 180-day all-cause mortality [hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.31–0.77; HR 0.62, 95% CI 0.45–0.85, respectively], compared with 1 ≤ mRSI < 1.25 (all P < 0.001). Conversely, an mRSI <0.75 was associated with a significantly higher incidence of 60-day and 180-day all-cause mortality (adjusted HR 2.08, 95% CI 1.19–3.62; HR 2.24, 95% CI 1.53–3.27; all P < 0.001). The benefit associated with mRSI ≥1.25 was consistent in sub-group analyses. The correlation of mRSI and outcomes were also consistent regardless of admission SBP, presence of atrial fibrillation, or use of beta blockers at discharge. Conclusions: In patients hospitalized for HFrEF, the mRSI was a significant predictor of early outcomes. The mRSI could be used as a tool to assess patient status and guide physicians in treating patients with HFrEF.

Original languageEnglish
Pages (from-to)3232-3240
Number of pages9
JournalESC Heart Failure
Volume9
Issue number5
DOIs
Publication statusPublished - 2022 Oct

Bibliographical note

Publisher Copyright:
© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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