Pressure-Adjusted Heart Rate Predicts Mortality and Resource Utilization in Cardiogenic Shock: An Analysis of the MIMIC-IV Database.

BACKGROUND: Pressure-Adjusted Heart Rate (PAHR) is a novel hemodynamic index in cardiogenic shock (CS); however, its dynamic outcome remains underexplored. METHODS: In this retrospective cohort study, which utilized the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, PAHR was calculated using at least 12 time-matched values of mean arterial pressure (MAP), central venous pressure (CVP), and heart rate (HR) over the first 48 h. Patients receiving early mechanical circulatory support (MCS) were excluded. Multivariable regression assessed PAHR's association with mortality, requirement of renal replacement therapy (RRT), and invasive mechanical ventilation. Effect estimates were reported per 10-unit increments of PAHR. RESULTS: A total of 772 patients with CS were included. Mean PAHR was 15.9 ± 7.0. In our multivariable analysis, every 10-unit PAHR increase independently predicted in-hospital mortality (adjusted OR 1.97; 95% CI 1.45-2.68; p < 0.001). Using statistically comparable increments, PAHR showed strong association with in-hospital mortality (adjusted OR 1.97; 95% CI 1.45-2.68; p < 0.001) and ICU mortality (adjusted OR 1.85; 95% CI 1.35-2.54; p < 0.001). PAHR strongly predicted the use of RRT (aOR 2.69; p < 0.001) and invasive mechanical ventilation (aOR 2.11; p < 0.001). Among survivors, higher PAHR predicted prolonged ICU stay and vasopressor duration (p < 0.001). CONCLUSION: PAHR is a promising integrated marker of mortality and morbidity in patients with CS. It serves as a sustained predictor of outcomes, though external validation is required.