Evidence map›Paper›PMID 25281655›Full record

Trial reportCirculation. Heart failure2014

Hypotension during hospitalization for acute heart failure is independently associated with 30-day mortality: findings from ASCEND-HF.

Priyesh A Patel, Gretchen Heizer, Christopher M O'Connor, Phillip J Schulte, Kenneth Dickstein, Justin A Ezekowitz, Paul W Armstrong, Vic Hasselblad, Roger M Mills, John J V McMurray and 4 more

Registry-linked trialOpen access · greenAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Circulation. Heart failure, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00475852 (Double-Blind, Placebo-Controlled, Multicenter Acute Study of Clinical Effectiveness of Nesiritide in Subjects With Decompensated Heart Failure), which is not on this map. Cited by 25 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
25citing papers in PubMed, 1 pooled it
3.2field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00475852 phase3completednot on this map

Double-Blind, Placebo-Controlled, Multicenter Acute Study of Clinical Effectiveness of Nesiritide in Subjects With Decompensated Heart Failure (ASCEND-HF)

TypeinterventionalSponsorScios, Inc.Ran2007 to 2011Enrolled7,141ConditionsHeart DecompensationArmsNesiritide, Placebo
3 · Its place in the literature

Who cites it

25 citing papers in PubMed, 1 synthesis or guideline pooled it, 57 citations in OpenAlex.

  1. Pooled it
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  7. Early drop in blood pressure following angiotensin receptor-neprilysin inhibitor initiation in decompensated heart failure.Hypertension research : official journal of the Japanese Society of Hypertension · 2026
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  15. Observational
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 5 institutions in 3 countries.

Priyesh A PatelFrom the Duke Clinical Research Institute, Durham, NC (P.A.P., G.H., C.M.O., P.J.S., V.H., R.M.C., A.F.H.); Duke University Medical Center, Durham, NC (C.M.O., R.M.C., A.F.H.); Central Hospital Cardiology Division, Stavanger, Norway (K.D.); Division of Cardiology, Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E., P.W.A.); Janssen Research & Development, LLC, Raritan, NJ (R.M.M.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Cleveland Clinic Foundation, OH (R.C.S., W.H.W.T.). priyesh.patel@dm.duke.edu.
Gretchen HeizerFrom the Duke Clinical Research Institute, Durham, NC (P.A.P., G.H., C.M.O., P.J.S., V.H., R.M.C., A.F.H.); Duke University Medical Center, Durham, NC (C.M.O., R.M.C., A.F.H.); Central Hospital Cardiology Division, Stavanger, Norway (K.D.); Division of Cardiology, Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E., P.W.A.); Janssen Research & Development, LLC, Raritan, NJ (R.M.M.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Cleveland Clinic Foundation, OH (R.C.S., W.H.W.T.).
Christopher M O'ConnorFrom the Duke Clinical Research Institute, Durham, NC (P.A.P., G.H., C.M.O., P.J.S., V.H., R.M.C., A.F.H.); Duke University Medical Center, Durham, NC (C.M.O., R.M.C., A.F.H.); Central Hospital Cardiology Division, Stavanger, Norway (K.D.); Division of Cardiology, Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E., P.W.A.); Janssen Research & Development, LLC, Raritan, NJ (R.M.M.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Cleveland Clinic Foundation, OH (R.C.S., W.H.W.T.).
Phillip J SchulteFrom the Duke Clinical Research Institute, Durham, NC (P.A.P., G.H., C.M.O., P.J.S., V.H., R.M.C., A.F.H.); Duke University Medical Center, Durham, NC (C.M.O., R.M.C., A.F.H.); Central Hospital Cardiology Division, Stavanger, Norway (K.D.); Division of Cardiology, Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E., P.W.A.); Janssen Research & Development, LLC, Raritan, NJ (R.M.M.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Cleveland Clinic Foundation, OH (R.C.S., W.H.W.T.).
Kenneth DicksteinFrom the Duke Clinical Research Institute, Durham, NC (P.A.P., G.H., C.M.O., P.J.S., V.H., R.M.C., A.F.H.); Duke University Medical Center, Durham, NC (C.M.O., R.M.C., A.F.H.); Central Hospital Cardiology Division, Stavanger, Norway (K.D.); Division of Cardiology, Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E., P.W.A.); Janssen Research & Development, LLC, Raritan, NJ (R.M.M.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Cleveland Clinic Foundation, OH (R.C.S., W.H.W.T.).
Justin A EzekowitzFrom the Duke Clinical Research Institute, Durham, NC (P.A.P., G.H., C.M.O., P.J.S., V.H., R.M.C., A.F.H.); Duke University Medical Center, Durham, NC (C.M.O., R.M.C., A.F.H.); Central Hospital Cardiology Division, Stavanger, Norway (K.D.); Division of Cardiology, Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E., P.W.A.); Janssen Research & Development, LLC, Raritan, NJ (R.M.M.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Cleveland Clinic Foundation, OH (R.C.S., W.H.W.T.).
Paul W ArmstrongFrom the Duke Clinical Research Institute, Durham, NC (P.A.P., G.H., C.M.O., P.J.S., V.H., R.M.C., A.F.H.); Duke University Medical Center, Durham, NC (C.M.O., R.M.C., A.F.H.); Central Hospital Cardiology Division, Stavanger, Norway (K.D.); Division of Cardiology, Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E., P.W.A.); Janssen Research & Development, LLC, Raritan, NJ (R.M.M.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Cleveland Clinic Foundation, OH (R.C.S., W.H.W.T.).
Vic HasselbladFrom the Duke Clinical Research Institute, Durham, NC (P.A.P., G.H., C.M.O., P.J.S., V.H., R.M.C., A.F.H.); Duke University Medical Center, Durham, NC (C.M.O., R.M.C., A.F.H.); Central Hospital Cardiology Division, Stavanger, Norway (K.D.); Division of Cardiology, Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E., P.W.A.); Janssen Research & Development, LLC, Raritan, NJ (R.M.M.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Cleveland Clinic Foundation, OH (R.C.S., W.H.W.T.).
Roger M MillsFrom the Duke Clinical Research Institute, Durham, NC (P.A.P., G.H., C.M.O., P.J.S., V.H., R.M.C., A.F.H.); Duke University Medical Center, Durham, NC (C.M.O., R.M.C., A.F.H.); Central Hospital Cardiology Division, Stavanger, Norway (K.D.); Division of Cardiology, Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E., P.W.A.); Janssen Research & Development, LLC, Raritan, NJ (R.M.M.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Cleveland Clinic Foundation, OH (R.C.S., W.H.W.T.).
John J V McMurrayFrom the Duke Clinical Research Institute, Durham, NC (P.A.P., G.H., C.M.O., P.J.S., V.H., R.M.C., A.F.H.); Duke University Medical Center, Durham, NC (C.M.O., R.M.C., A.F.H.); Central Hospital Cardiology Division, Stavanger, Norway (K.D.); Division of Cardiology, Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E., P.W.A.); Janssen Research & Development, LLC, Raritan, NJ (R.M.M.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Cleveland Clinic Foundation, OH (R.C.S., W.H.W.T.).
Randall C StarlingFrom the Duke Clinical Research Institute, Durham, NC (P.A.P., G.H., C.M.O., P.J.S., V.H., R.M.C., A.F.H.); Duke University Medical Center, Durham, NC (C.M.O., R.M.C., A.F.H.); Central Hospital Cardiology Division, Stavanger, Norway (K.D.); Division of Cardiology, Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E., P.W.A.); Janssen Research & Development, LLC, Raritan, NJ (R.M.M.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Cleveland Clinic Foundation, OH (R.C.S., W.H.W.T.).
W H Wilson TangFrom the Duke Clinical Research Institute, Durham, NC (P.A.P., G.H., C.M.O., P.J.S., V.H., R.M.C., A.F.H.); Duke University Medical Center, Durham, NC (C.M.O., R.M.C., A.F.H.); Central Hospital Cardiology Division, Stavanger, Norway (K.D.); Division of Cardiology, Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E., P.W.A.); Janssen Research & Development, LLC, Raritan, NJ (R.M.M.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Cleveland Clinic Foundation, OH (R.C.S., W.H.W.T.).
Robert M CaliffFrom the Duke Clinical Research Institute, Durham, NC (P.A.P., G.H., C.M.O., P.J.S., V.H., R.M.C., A.F.H.); Duke University Medical Center, Durham, NC (C.M.O., R.M.C., A.F.H.); Central Hospital Cardiology Division, Stavanger, Norway (K.D.); Division of Cardiology, Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E., P.W.A.); Janssen Research & Development, LLC, Raritan, NJ (R.M.M.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Cleveland Clinic Foundation, OH (R.C.S., W.H.W.T.).
Adrian F HernandezFrom the Duke Clinical Research Institute, Durham, NC (P.A.P., G.H., C.M.O., P.J.S., V.H., R.M.C., A.F.H.); Duke University Medical Center, Durham, NC (C.M.O., R.M.C., A.F.H.); Central Hospital Cardiology Division, Stavanger, Norway (K.D.); Division of Cardiology, Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Canada (J.A.E., P.W.A.); Janssen Research & Development, LLC, Raritan, NJ (R.M.M.); Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom (J.J.V.M.); Cleveland Clinic Foundation, OH (R.C.S., W.H.W.T.).
Duke University Hospital · USUniversity of Alberta · CAJanssen (United States) · USDuke Medical Center · USUniversity of Glasgow · GB

Funding

MULTIDISCIPLINARY HEART &VASCULAR DISEASEST32HL007101 · NHLBI · DUKE UNIVERSITY · PI FREEDMAN, NEIL J. · 1985 to 2020
$9.8M
NHLBI NIH HHS T32 HL007101NHLBI NIH HHS T32-HL007101
6 · The paper itself

Abstract

backgroundOutcomes associated with episodes of hypotension while hospitalized with acute decompensated heart failure are not well understood. METHODS AND

resultsUsing data from Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF), we assessed factors associated with in-hospital hypotension and subsequent 30-day outcomes. Patients were classified as having symptomatic or asymptomatic hypotension. Multivariable logistic regression was used to determine factors associated with in-hospital hypotension, and Cox proportional hazards models were used to assess the association between hypotension and 30-day outcomes. We also tested for treatment interaction with nesiritide on 30-day outcomes and the association between in-hospital hypotension and renal function at hospital discharge. Overall, 1555 of 7141 (21.8%) patients had an episode of hypotension, of which 73.1% were asymptomatic and 26.9% were symptomatic. Factors strongly associated with in-hospital hypotension included randomization to nesiritide (odds ratio, 1.98; 95% confidence interval [CI], 1.76-2.23; P<0.001), chronic metolazone therapy (odds ratio, 1.74; 95% CI, 1.17-2.60; P<0.001), and baseline orthopnea (odds ratio, 1.31; 95% CI, 1.13-1.52; P=0.001) or S3 gallop (odds ratio, 1.21; 95% CI, 1.06-1.40; P=0.006). In-hospital hypotension was associated with increased hazard of 30-day mortality (hazard ratio, 2.03; 95% CI, 1.57-2.61; P<0.001), 30-day heart failure hospitalization or mortality (hazard ratio, 1.58; 95% CI, 1.34-1.86; P<0.001), and 30-day all-cause hospitalization or mortality (hazard ratio, 1.40; 95% CI, 1.22-1.61; P<0.001). Nesiritide had no interaction on the relationship between hypotension and 30-day outcomes (interaction P=0.874 for death, P=0.908 for death/heart failure hospitalization, P=0.238 death/all-cause hospitalization).

conclusionsHypotension while hospitalized for acute decompensated heart failure is an independent risk factor for adverse 30-day outcomes, and its occurrence highlights the need for modified treatment strategies. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00475852.

Indexed as

Heart FailureHospital MortalityHypotensionAgedFemaleHospitalizationHumansLogistic ModelsMaleMiddle AgedNatriuretic AgentsNatriuretic Peptide, BrainOutcome Assessment, Health CarePrognosisProportional Hazards ModelsNatriuretic AgentsNatriuretic Peptide, Brainheart failurehypotensionnatriuretic peptide, brain

Identifiers

PMID25281655
PMCPMC4456178
OpenAlexW2002397667

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Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.