Abstract 219: Systolic Blood Pressure on ER Arrival and its Impact on In-Hospital Mortality in Patients With Acute Heart Failure

Abstract

Background: Evaluating patients with acute heart failure (AHF) in ER is still a significant challenge. Accurate management of AHF is a time-dependent event and the triage process must be initiated immediately once the symptoms of HF are identified. However, detailed clinical information is often unknown in patients presenting with AHF. Large controlled trials conducted on chronic heart failure have identified therapies that improve clinical outcomes. In contrast, few large and randomized AHF trials have been conducted over the last 2 decades, and few significant predictors and treatments are available for AHF. Purpose: To determine whether the ER assessment information could be used to predict patients’ acute outcome. Methods: We extracted data of patients admitted with acute HF from Tokyo CCU Network database (TCND) from 2005 to 2007. TCND collected information of patients who were emergently admitted to acute cardiac care facilities from 62 participating hospitals in the Tokyo metropolitan area. We identified 2220 patients who were admitted for AHF. AHF was defined as a rapid onset or change in the signs and symptoms of HF, resulting in a need for urgent therapy. Patients with ACS were excluded from this analysis. A logistic regression analysis was performed to detect the predictors of in-hospital mortality. Results: The patients were predominantly elderly (74.4±12.6) and male (55.1%). There were 154 (6.9%) in-hospital deaths. Significant predictors of in-hospital death were age (OR 1.02; p<0.001), history of chronic lung disease (OR 2.06; p=0.02), and systolic blood pressure values on presentation (OR 3.12; p<0.001 for SBP <90mmHg, and OR 0.64; p<0.001 for SBP 90-130mmHg). Conclusion: Systolic BP on presentation was the key indicator for AHF risk stratification, and it was inversely correlated with in-hospital mortality.