Abstract 5917: Impact Of Blood Pressure At Hospital Discharge On Mortality In The Acute To Chronic Heart Failure Transition
In stabilized heart failure (HF) patients, blood pressure targets that yield optimal outcomes have not been determined. We determined the mortality impact of discharge systolic blood pressure (SBPd) and diastolic blood pressure (DBPd) during the transition from acute to chronic HF. In the Enhanced Feedback For Effective Cardiac Treatment (EFFECT) study, we examined long-term survival in 7748 HF patients, using risk-adjusted time-to-event analysis. Patients were categorized into 5 groups based on SBPd: <100 (n=691), 100–119 (n=2350), 120–139 (n=2427), 140–159 (n=1379), or >=160 (n=601) mmHg. Similarly, patients were categorized according to DBPd: <55 (n=848), 55–64 (n=2173), 65–74 (n=2318), 75–84 (n=1432), or >=85 (n=677) mmHg. A total of 22,259 person-years were examined (3720 [49.9%] men, mean age 75.2±11.5 yrs). Overall, compared with SBPd 120–139 (referent), those with SBPd<100 had 26% earlier adjusted median time to death with a survival time ratio [STR] of 0.74 (95%CI, 0.66 – 0.84, p<0.001). SBPd in the “low-normal” range (100 –119mmHg) was also associated with shortened survival, with STR 0.90 (95%CI, 0.83–0.98, p=0.019). Stratified by left ventricular ejection fraction (LVEF<<26>40% vs. >40%), SBPd was associated with survival in a U-shaped relationship (Table⇓). Low DBPd (<55mmHg) was associated with decreased survival overall (STR 0.84; 95%CI, 0.75–0.94, p=0.002). In those with LVEF<<26>40%, STR was 0.81 (95%CI, 0.64–1.02, p=0.07) for DBPd <55mmHg and 0.81 (95%CI, 0.68 – 0.97, p=0.019) for DBPd 55–64mmHg. For LVEF>40% and DBPd <55mmHg, STR was 0.72 (95%CI, 0.57–0.91, p=0.006). SBPd is a significant prognostic factor in “post-acute” and early chronic HF, with a U-shaped relationship with mortality. The risk of death increased at lower SBPd and DBPd values that are considered to be within the “normal” range.