Influence of mean arterial pressure on 6-month readmission and mortality in elderly patients with heart failure

LV Yue; LI Shan; GE Jie

PDF(1147 KB)

Medical Journal of the Chinese People Armed Police Forces ›› 2025, Vol. 36 ›› Issue (10) : 841-847.

ORIGINAL ARTICLES

Influence of mean arterial pressure on 6-month readmission and mortality in elderly patients with heart failure

LV Yue, LI Shan, GE Jie

Author information +

History +

Abstract

Objective To explore the influence of mean arterial pressure (MAP) on 6-month readmission and mortality in elderly patients with heart failure. Methods A retrospective study was conducted on the clinical data of 1,826 patients from the heart failure database of Zigong city from December 2016 to June 2019. PostgreSQL 9.6 software was used to extract the data from the MIMIC-Ⅳ database. The patients were divided into four groups according to MAP levels, and three different models, including the crude model, were established. Statistical analyses were performed on the models. Model 2 (adjusted for gender and age) and Model 3 (adjusted for all potential factors) were used to establish generalized linear models and generate smoothed fitting curves for MAP in relation to 6-month readmission and mortality. Cox proportional hazards regression models were employed to compare the impact of different MAP levels on 6-month readmission and mortality. Restricted cubic spline regression models were used to explore the response relationship between MAP and 6-month readmission and mortality, and comparisons were made through log-rank tests. Results A total of 1,826 patients were included in this study, including 743 males and 1,083 females. The analysis revealed a non-linear association between MAP and the risks of mortality and readmission in the patients with heart failure. Particularly in elderly patients with heart failure, MAP levels demonstrated a significant correlation with the 6-month readmission and mortality. After multivariable adjustment, no statistically significant differences were observed in the 6-month readmission or mortality between the patients with MAP below 83.33 mmHg and those with MAP in the range of 83.33 to 94 mmHg. However, the patients with MAP values between 94 and 105.33 mmHg exhibited a 30% lower risk of readmission and a 28% lower risk of mortality compared to those with lower MAP levels, respectively. Higher average MAP levels were significantly linked to a lower risk of 6-month readmission, as well as the composite endpoint encompassing the 6-month readmission and mortality. After adjusting for multiple variables, this association persisted, indicating that MAP levels might serve as a significant independent prognostic factor in the elderly population. Specifically, the risks increased when MAP levels were below 83.33 mmHg or above 105.33 mmHg, the risk increased. Conclusions MAP is associated with the risks of 6-month mortality and readmission among patients with heart failure, showing a J-shaped curve relationship.

Key words

mean arterial pressure / heart failure / readmission / all-cause mortality / cohort study

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

LV Yue, LI Shan, GE Jie. Influence of mean arterial pressure on 6-month readmission and mortality in elderly patients with heart failure[J]. Medical Journal of the Chinese People Armed Police Forces. 2025, 36(10): 841-847

References

[1] 黎兴. 老年慢性心力衰竭患者多病共存现状研究[D].沈阳:沈阳大学,2025.
[2] Saito K, Nakade T, Kagiyama N, et al. sarcopenia in heart failure: comparison of prognostic value between the asian working group for sarcopenia 2014 and 2019 criteria[J]. Geriatr Gerontol In, 2025, 25(6):764-771.
[3] Fu Z, Zhang X, Zhao X, et al. U-shaped relationship of sodium-to-chloride ratio on admission and mortality in elderly patients with heart failure: a retrospective cohort study[J]. Curr Probl Cardiol, 2023, 48(1): 101419.
[4] 何晓雯, 曾桂芳, 冯洁, 等. 湖南部分地区慢性心力衰竭再入院率及影响因素调查[J]. 湖南师范大学学报(医学版), 2021, 18(1): 50-54.
[5] Murru V, Belfiori E, Sestu A, et al. Patterns of comorbidities differentially impact on in-hospital outcomes in heart failure patients[J]. BMC Geriatr, 2025, 25(1): 371.
[6] 张铭瑞, 崔雯霞, 高蕾, 等. 老年高血压病人合并射血分数保留的心力衰竭的临床特征及相关危险因素分析[J]. 实用老年医学, 2022, 36(12): 1247-1250.
[7] 储雪雁, 宋凯, 汪永林, 等. 高血压患者血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂相关基因突变率差异的单臂Meta分析[J]. 武警医学, 2025, 36(3): 190-196.
[8] Gallo G, Savoia C. Hypertension and heart failure: from pathophysiology to treatment[J]. Int J Mol Sci, 2024, 25(12): 6661.
[9] Karway G K, Krzyzanowski B, Killion J A, et al. Regional variability of the impact of cardiometabolic diseases on incident dementia in United States Medicare beneficiaries[J]. Alzheimers Dement, 2025, 21(5): e70199.
[10] Liu Z J, Liu X H, Zhang QX, et al. A novel indicator derived from heart sound energy map obtained by a wearable device can evaluate LV function[J]. Postgrad Med J, 2025, Apr 28;(0).
[11] Lip S, Tan L E, Jeemon P,et al. Diastolic blood pressure J-curve phenomenon in a tertiary-care hypertension clinic[J]. Hypertension, 2019, 74(4): 767-775.
[12] 范光德, 孙梦涵, 王坤伟. 老年高血压病患者平均动脉压水平与白细胞计数的关系[J]. 临床误诊误治, 2023, 36(6): 84-88.
[13] Zhang Z, Cao L, Chen R,et al.Electronic healthcare records and external outcome data for hospitalized patients with heart failure[J].Sci Data,2021,8(1):46.
[14] 谢婧雯, 尹微, 江翊国等. 临床药师主导的心力衰竭患者指南导向药物治疗管理与评价[J]. 实用药物与临床, 2025, 28(6): 442-446.
[15] 唐婷, 胡凤丽, 孙伟, 等. 2023年ACC射血分数保留的心力衰竭患者管理指南解读. 河北医科大学学报[J], 2024, 45(12): 1369-1373.
[16] Huo R, Wei C, Yang Y, et al. Mortality associated with systemic lupus erythematosus combined with heart failure in the United States (1999-2020): a multiple-cause-of-death study[J]. Medicine (Baltimore), 2025, 104(21): e42548.
[17] 韦少平, 邱鹏远, 曾文苑, 等. 超声心动图评价妊娠期高血压疾病患者左心室舒张功能在早期心力衰竭的应用价值[J].中国医疗器械信息, 2024. 30(15): 111-113.
[18] 朱健飞, 孙帅. 心率与高血压致主动脉夹层机制的研究进展[J].心血管病学进展, 2025, 46(5): 408-411.
[19] 陈其然. 院内心脏骤停患者时间加权平均动脉压与急性肾损伤的关系[D].济南:山东大学,2024.
[20] 刘雪梅, 王雅婷, 吴寿岭. 高尿酸血症人群平均动脉压水平与踝臂脉搏波传导速度的相关性分析[J]. 中国临床保健杂志, 2023, 26(6): 757-761.
[21] Skouri H, Girerd N, Monzo L, et al. Clinical management and therapeutic optimization of patients with heart failure with reduced ejection fraction and low blood pressure. A clinical consensus statement of the Heart Failure Association (HFA) of the ESC[J]. Eur J Heart Fail, 2025, 27(4): 707-722.
[22] Magnussen C, Niiranen T J, Ojeda F M, et al. Sex-specific epidemiology of heart failure risk and mortality in europe: results from the biomarCaRE consortium[J]. JACC Heart Fail, 2019, 7(3): 204-213.
[23] 梁蓉. 冠心病伴慢性心力衰竭患者心率变异性及其与病情严重程度的相关性[J]. 武警医学, 2025, 36(2): 138-140.
[24] Shin S, Austin P C, Ross H J, et al. Machine learning vs. conventional statistical models for predicting heart failure readmission and mortality[J]. ESC Heart Fail, 2021, 8(1): 106-115.
[25] Zhang X, Yao Y, Zhang Y, et al. Prognostic value of patient-reported outcomes in predicting 30 day all-cause readmission among older patients with heart failure[J]. ESC Heart Fail, 2022, 9(5): 2840-2850.
[26] Han Q, Ren J, Tian J, et al. A nomogram based on a patient-reported outcomes measure: predicting the risk of readmission for patients with chronic heart failure[J]. Health Qual Life Outcomes, 2020, 18(1): 290.
[27] 邱小芩, 黄彩献, 傅桂芬, 等. 慢性心力衰竭患者院外健康管理程序的构建及应用[J]. 中华护理杂志, 2022, 57(4): 401-407.