Kelsey Vonderheide, PA1

 Heart Failure—a large number of conditions affecting the structure and function of the heart that make it difficult for the heart to meet the body’s needs  In the US, 5.7 million people are currently affected by Heart Failure  Heart Failure occurs in 10 of every 1000 people over the age of 65  Approximately every 25 seconds, an American will have a coronary event  Approximately every minute, someone will die of one.

Entered “harm AND heart failure” into Google Scholar Found the HTML of the article at the Journal of the American College of Cardiology website Clicked on “Full Text”

Pulse Pressure and Risk for Myocardial Infarction and Heart Failure in the Elderly

 Determine whether pulse pressure is an independent predictor of the incidence of coronary heart disease, congestive heart failure, and overall mortality among the elderly in a specific community in New Haven, Connecticut  FYI: Pulse Pressure = a measurement of arterial stiffness

 Cohort study of 2,152 individuals age 65+  Exclusion Criteria  History of MI  Possible CHF at baseline  Individuals who did not have BP measurements available  Subjects for whom the cause of death could not be determined for certain  Subjects who died within the first year of follow-up  Three seating SBP and DBP readings were obtained, and the average of the 2 nd and 3 rd were used  Pulse pressure was then calculated as the difference between SBP and DBP  Study participants were assessed over a 10-year follow-up period

 During the 10-year follow-up…  328 CHD events occurred  174 validated MIs  154 CHD deaths with no prior MI  224 CHF events occurred  198 hospitalizations for CHF  24 deaths due to CHF with no prior CHF hospitalization  1,046 deaths from any cause

 For each 10 mmHg increment in Pulse Pressure (after baseline factors were adjusted for), there was…  12% increase in risk for CHD  14% increase in risk for CHF  6% increase in risk for total mortality  Older individuals, unmarried individuals, and those with diabetes or a history of hypertension tended to have higher mean PP

 Pulse pressure is an independent and significant predictor of the incidence of CHD and CHF among the elderly  Independent of MAP, SBP, DBP, and hypertension classification  Pulse pressure magnitude is associated with cardiovascular end points in normotensive individuals and those with isolated systolic hypertension.  This association does not hold true for isolated diastolic hypertension.

 Although there were not specific experimental and cohort groups, the study subjects were randomly chosen from a community in New Haven, Connecticut by obtaining a probability sample.  A probability sample is defined as being any method of sampling that utilizes some form of random selection

 N/A because there were no experimental/ control groups.  However, had there been only 2 distinct groups, the researcher would want the randomization list to be concealed to prevent bias.

 Yes  Patients were grouped according to their baseline pulse pressures

 Yes.  Because people who had a history of MI and/or possible CHF were excluded from the study, we can assume that PP was indeed at least part of the reason for the outcome

 Yes, participants were studied over a 10 year period.  Information was obtained on >99% of the cohort members.  It did not matter if they died during the duration of the study as long as the researchers were able to identify the cause of death.

 This is a cohort study. Therefore relative risk is used to measure the magnitude of association.  CHD Incidence RR= 1.12  CHF Incidence RR= 1.14  Total Mortality RR= 1.06  These RR values were obtained after adjusting for age, gender, and other factors.

Chart indicates that the effect of PP was seen in all individuals except those with diastolic hypertension. Indicates isolated systolic hypertension is not a major mediator in the effect of PP

 Most of the PP effect on CHD risk was actually seen in the group of subjects without hypertension who were not taking medications for high blood pressure.  These results suggest that the use of antihypertensive medications does not change the association between PP and cardiovascular end points.

 To determine the precision of the estimate of association, confidence intervals are used. Confidence intervals spanning a large range, are not as useful as those with a smaller range.  CHD IncidenceRR= 1.12CI (95%)=  CHF IncidenceRR= 1.14CI (95%)=  Total MortalityRR= 1.06CI (95%)=  Values adjusted for age, gender, and other factors

Journal of the American College of Cardiology Dr. John Lucich