Pupil size predicts death and readmission in patients with heart failure

Pupil size predicts death and readmission in heart failure patients, according to a study published today ESC heart failure, Journal of the European Society of Cardiology (ESC).¹

“Our results suggest that the pupillary region is a new way to identify heart patients at increased risk of death or readmission,” said study author Kitasato University Hospital, Kohei Nozaki in Kanagawa Prefecture. Said the doctor. “This gives us the opportunity to intervene and improve our outlook.”

Currently, approximately 26 million people worldwide have heart failure. It is a life-threatening condition in which the heart cannot pump enough blood to meet the body’s needs.

Symptoms include shortness of breath, swollen limbs, and fatigue. Up to 45% of patients hospitalized for heart failure die within 1 year of admission, and the majority die within 5 years of admission.²

“It’s important to find better ways to identify which patients are more likely to be readmitted or die,” Dr. Nozaki said.

One of the causes of worsening heart failure is the dysfunction of the body’s autonomic nervous system, which controls heart rate, digestion, and respiration. Autonomic function is usually assessed by measuring changes in heart rate.

However, this method does not work for patients with a heart rhythm disorder called atrial fibrillation, which is common in patients with heart failure.

The pupillary area is another way to assess autonomic function and is used in patients with Parkinson’s disease and diabetes. This study investigated whether pupil area could predict the prognosis of patients with heart failure.

The study was conducted on 870 patients hospitalized for acute heart failure between 2012 and 2017. The average age was 67, and 37% were female. Pupillary area was measured in both eyes at least 7 days after admission.

In the test, patients put on goggles, wait 5 minutes for their eyes to darken, and then took a picture of their eyes. Patients were tested at standard time (between 09:00 and 12:00) as the autonomous system is time sensitive.

Patients were divided into small and large pupillary area groups, depending on whether the measurements were below or above the median (16.6 mm).²).

Subsequently, all-cause mortality (primary endpoint) and readmission for heart failure (secondary endpoint) were followed up. We compared the results of the small and large pupil region groups.

Over a median follow-up of 1.9 years, 131 patients died and 328 were readmitted due to heart failure. Compared to the large pupil area group, patients in the small pupil area group had significantly lower survival rates and significantly higher readmission rates for heart failure.

After adjusting for other factors that may affect prognosis, such as body mass index (BMI) and renal function, patients with small pupil areas have a 28% lower risk of all-cause mortality and a risk of re-hospitalization due to heart failure. Compared to patients with large pupil area, which decreased by 18%.

Large pupil area was consistently associated with favorable survival regardless of age, gender, and presence of normal heart rhythm or atrial fibrillation.

The pupil area can be obtained quickly, easily and non-invasively. Our study shows that it can be used in routine practice to predict the prognosis of patients with heart failure, including those with heart failure who also have atrial fibrillation. Patients with small pupil area (eg <16.6 mm)²) Can prioritize cardiac rehabilitation with physical activity that has been reported to improve autonomic function. “

Kitasato University Hospital Research author Kohei Nozaki

Dr. Nozaki said that the pupillary area cannot be used in patients with severe retinopathy or other eye disorders.