The impact of low blood pressure at discharge on long term clinical outcome in patients with acute heart failure

Abstract Background/Introduction Low blood pressure (LBP) is significantly associated with poor clinical outcomes in patients with heart failure. However, in patients with acute heart failure (AHF), it remains uncertain whether LBP on admission or at discharge is a more significant predictor of long-term clinical outcomes in the current setting. Methods We prospectively investigated 402 consecutive hospitalized patients with AHF at four hospitals in Japan between May 2021 and March 2023. LBP was defined as a blood pressure of 90 mmHg either on admission or at discharge. The primary endpoint was all-cause mortality. We assessed the prognostic value of LBP using univariate and multivariate Cox regression analyses. Results Among the 402 patients evaluated (median age 79.0 years, interquartile range IQR 69.0–85.0 years, 61.2% male), 11 patients (2.7%) had LBP on admission, and 38 patients (9.4%) had LBP at discharge. The median follow-up period was 1.3 years, during which 68 patients died. The initiation of fantastic four heart failure at discharge was 24.8% (4/4), 56.9% (3/4), 82.0% (2/4), 96.6% (1/4). The cumulative incidence of all-cause mortality after discharge was significantly higher in the discharge LBP group (log-rank p = 0.026), but not in the admission LBP group (log-rank p = 0.700). Multivariate Cox regression analysis showed that admission LBP was not significantly associated with higher mortality (adjusted hazard ratio HR 1.78, 95% confidence interval CI 0.41–7.63, p = 0.438), whereas discharge LBP was significantly associated with higher mortality (adjusted HR 2.18, 95% CI 1.07–4.46, p = 0.031). Conclusions In hospitalized patients with AHF, LBP was more prevalent at discharge than on admission. Discharge LBP, but not admission LBP, was significantly associated with poor long-term clinical outcomes. This study reports the prognostic significance of LBP at discharge in AHF patients based on a contemporary registry with advanced medical therapy, providing novel insights into the management of these patients.