Usefulness of Combined Risk Stratification With Heart Rate and Systolic Blood Pressure in the Management of Chronic Heart Failure:– A Report From the CHART-2 Study –
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概要
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Background: The appropriate target ranges of heart rate (HR) and systolic blood pressure (SBP) for the management of chronic heart failure (CHF) patients remain to be elucidated in a large-scale cohort study. Methods and Results: We examined 3,029 consecutive CHF patients with sinus rhythm (SR) (mean age, 67.9 years) registered in the Chronic Heart Failure Analysis and Registry in the Tohoku District-2 Study (CHART-2; NCT00418041). There were 357 deaths (11.8%) during the median follow-up of 3.1 years. We first performed the classification and regression tree analysis for mortality, identifying SBP <89mmHg, HR >70beats/min and SBP <115mmHg as the primary, secondary and tertiary discriminators, respectively. According to these, we divided the patients into low- (n=1,131), middle- (n=1,624) and high-risk (n=274) groups with mortality risk <10%, 10–20% and >20%, respectively. The low-risk group was characterized by SBP >115mmHg and HR <70beats/min and the high-risk group by SBP <89mmHg regardless of HR values or SBP 89–115mmHg and HR >76beats/min. Multivariate Cox regression analysis revealed that the hazard ratio of all-cause death for low-, middle- and high-risk groups was 1.00 (reference), 1.48 (95% confidence interval (CI): 1.10–1.99, P=0.009) and 2.44 (95% CI 1.66–3.58, P<0.001), respectively. Subgroup analysis revealed that age ≥70 years, diabetes, or reduced left ventricular function had higher hazard ratios in the high-risk group. Conclusions: The results demonstrate the usefulness of combined risk stratification of HR and SBP in CHF patients with SR.
- 一般社団法人 日本循環器学会の論文
著者
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Shiba Nobuyuki
Department Of Cardiovascular Medicine Tohoku University Graduate School Of Medicine
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Shimokawa Hiroaki
Department Of Cardiology Tohoku University School Of Medicine
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Takahashi Jun
Department Of Cardiology Iwate Prefectural Central Hospital
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Nochioka Kotaro
Department Of Cardiovascular Medicine Tohoku University Graduate School Of Medicine
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Sakata Yasuhiko
Department Of Advanced Medicine Nihon University School Of Medicine
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Miyata Satoshi
Department Of Genome Center Cancer Institute Hospital
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Miura Masanobu
Department Of Cardiovascular Medicine Tohoku University Graduate School Of Medicine
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Takada tsuyoshi
Department of Biochemistry, Nihon University School of Dentistry
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Sakata Yasuhiko
Departments of Cardiovascular Medicine and Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Tadaki Soichiro
Departments of Cardiovascular Medicine and Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Shimokawa Hiroaki
Departments of Cardiovascular Medicine and Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Miura Masanobu
Department of Cardiovascular Medicine and Department of Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Miyata Satoshi
Department of Cardiovascular Medicine and Department of Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Shiba Nobuyuki
Department of Cardiology, International University of Health and Welfare Hospital
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Takada Tsuyoshi
Departments of Cardiovascular Medicine and Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Nochioka Kotaro
Department of Cardiovascular Medicine and Department of Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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TAKAHASHI Jun
Department of Applied Chemistry and Biotechnology, University of Fukui
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