Abstract 11613: Prognostic Implication of Early Drop in Systolic Blood Pressure During the First 48 Hours in Patients with Acute Heart Failure from REALITY-AHF Registry

Abstract

Background: Although it has been suggested that excessive drop in systolic blood pressure (SBP) in the acute phase of acute heart failure potentially has a negative impact on prognosis, the association between changes in SBP during acute phase and prognosis has yet to be clarified. Methods and Results: This is the sub-analysis of REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure) study, which was a prospective, multicenter, observational registry which registered patients with acute heart failure admitted through emergency department (ED). Peak drop in SBP was defined as the difference between the baseline SBP values and the lowest values during the first 48 hours of hospitalization. After ED arrival, SBP was measured at the time of admission, 90 minutes, 6 hours, 24 hours, and 48 hours of ED admission. Patients were divided into three groups according to the value of peak SBP drop . A total of 1,656 patients were included in our study. Patients with greater peak SBP drop group was associated with higher baseline SBP and vasodilator use after admission. Cox proportional hazard analysis demonstrated greater peak SBP drop (per 10mmHg decrease) was independently associated with 180-day (hazard ratio, 1.12; 95% confidence interval, 1.01–1.23; P=0.027) and 1-year (hazard ratio, 1.12; 95% confidence interval, 1.03–1.21; P=0.006) mortality even after adjustment for confounding factors including baseline SBP (Figure). Conclusions: Early drop in SBP during first 48 hours of hospitalization was associated with all-cause mortality in patients with acute heart failure.