Correlation of Pre- and In-Hospital Systolic Blood Pressure in Acute Heart Failure Patients and the Prognostic Implications - Report From the Tokyo Cardiac Care Unit Network Emergency Medical Service Database

Background: Systolic blood pressure (SBP) is an important prognostic indicator for patients with acute heart failure (AHF). However, its changes and the effects in the different phases of the acute management process are not well known. Methods and Results: The Tokyo CCU Network prospectively collects on-site information about AHF from emergency medical services (EMS) and the emergency room (ER). The association between in-hospital death and SBP at 2 different time points (on-site SBP [measured by EMS] and in-hospital SBP [measured at the ER; ER-SBP]) was analyzed. From 2010 to 2012, a total of 5,669 patients were registered and stratified into groups according to both their on-site SBP and ER-SBP: >160 mmHg; 100-160 mmHg; and <100 mmHg. In-hospital mortality rates increased when both on-site SBP and ER-SBP were low. After multivariate adjustment, both SBPs were inversely associated with in-hospital death. Notably, the risk for patients with ER-SBP of 100-160 mmHg (intermediate risk) differed according to their on-site SBP; those with on-site SBP <100 or 100-160 mmHg were at higher risk (OR, 7.39; 95% CI, 4.00-13.6 and OR, 2.73; 95% CI, 1.83-4.08, respectively [P<0.001 for both]) than patients with on-site SBP >160 mmHg. Conclusions: Monitoring changes in SBP assisted risk stratification of AHF patients, particularly patients with intermediate ER-SBP measurements.