Abstract 20566: Lower Discharge Systolic Blood Pressure (SBP) and Poor Outcomes among Hospitalized Patients With Heart Failure and Preserved Ejection Fraction (HFpEF) and Stable Admission-to-Discharge SBP
Background: An admission SBP of <120 mm Hg has been shown to be associated with short-term poor outcomes in hospitalized patients with HF (PMID: 17090768). However, this association has not been well studied in hospitalized patients with HFpEF. We examined if a low discharge SBP among hospitalized HFpEF patients with a stable admission-to-discharge SBP was independently associated with poor outcomes.
Methods: In the Medicare-linked OPTIMIZE-HF registry, 10482 hospitalized patients with HF had EF >40%. A stable admission-to-discharge SBP was defined as SBP fluctuation of <20 mm Hg between hospital admission and discharge. Of the 4688 patients with stable SBP, 1325 (28%) had a discharge SBP of <120 mm Hg. Propensity scores for discharge SBP of <120 mm Hg, estimated for each of the 4688 patients, were used to assemble a cohort of 1096 pairs of patients, with a discharge SBP <120 vs ≥120 mm Hg, who were balanced on 58 baseline characteristics. The 2192 matched patients had a mean (±SD) age of 79 (±10) years, a mean (±SD) EF of 56 (±4) percent, a mean (±SD) discharge SBP of 122 (±17) mm Hg, 60% were women, and 7% African American.
Results: During 2.1 years of median follow-up (max, 5.9 years), all-cause mortality occurred in 75% and 70% of matched patients with a discharge SBP <120 vs ≥120 mm Hg, respectively (HR, 1.19; 95% CI, 1.08–1.31; Figure). A discharge SBP <120 mm Hg was also associated with a higher risk for the combined outcome of all-cause readmission or all-cause mortality (HR 1.10 (95% CI, 1.01–1.20) but not with all-cause readmission (HR, 1.07; 95% CI, 0.98–1.18) or HF readmission (HR, 1.03; 95% CI, 0.90–1.17). These associations remained unchanged when we repeated the above analyses among the 4688 pre-match patients, adjusting for propensity scores.
Conclusion: Among hospitalized patients with HFpEF and stable admission-to-discharge SBP, a low discharge SBP was independently associated with higher all-cause mortality but not with all-cause or HF readmissions.
Author Disclosures: A. Tsimploulis: None. P.H. Lam: None. D. Dooley: None. S. Weerakoon: None. C. Arundel: None. R.D. Fletcher: None. J. Butler: None. P. Deedwania: None. M. White: None. M.R. Blackman: None. C. Morgan: None. M. Banach: None. W.S. Aronow: None. C.W. Yancy: None. G.C. Fonarow: None. A. Ahmed: None.
- © 2016 by American Heart Association, Inc.