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Impact of Heart Failure Subtype on ICU and Hospital Mortality in Patients Admitted for Non-Cardiac Acute Respiratory Failure Requiring Mechanical Ventilation
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A3327 - Impact of Heart Failure Subtype on ICU and Hospital Mortality in Patients Admitted for Non-Cardiac Acute Respiratory Failure Requiring Mechanical Ventilation
Author Block: H. Mehta1, A. Vaidya1, C. Janick1, J. A. Weingarten2, R. Minkin1; 1Pulmonary, Critical Care and Sleep Medicine Division, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, United States, 2Pulmonary, Critical Care and Sleep Division, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, United States.
Introduction: Among patients admitted to the intensive care unit (ICU) for acute respiratory failure (ARF), approximately 30% require mechanical ventilation (MV). As significant numbers of these patients have congestive heart failure (CHF), clinicians need a better understanding of interactions between these diagnoses. The aim of this study was to determine ICU and hospital mortality among patients admitted for ARF due to non-cardiac reasons requiring MV. Subgroups of CHF, including heart failure with reduced ejection fraction (HFrEF), preserved ejection fraction (HFpEF), or combined systolic-diastolic CHF (CSDHF) were examined.
Methods: Single center, retrospective analysis of subjects requiring MV for ARF within a 3-year period. Subjects were selected based on ICD-9 codes. Medical records were reviewed to confirm diagnoses. Baseline characteristics including co-morbidities, echocardiogram results, ICU length of stay (LOS), hospital LOS, and all-cause ICU and hospital mortality were analyzed.
Results: 151 patients were identified, 78 (51.7%) with evidence of CHF: 28 (18.5%) subjects had HFrEF, 50 (33.1%) had HFpEF, and 13 (8.61%) had CSDHF. The mean (± SD) age was 70.1 ± 14.1. Mean ICU length of stay LOS (± SD) was 7.1 ± 10.3 days and mean hospital LOS (± SD) was 17.5 ± 21.7 days. There was an increased risk of hospital mortality among those with CSDHF compared with controls (69% vs 37%, p=0.03). There was a trend (p=0.054) towards increased risk of ICU death among those with CSDHF compared with controls. There were no significant differences in ICU or hospital mortality comparing either HFrEF or HFpEF vs controls, or HFrEF vs HFpEF.
Discussion: This retrospective analysis highlights the impact of comorbid heart failure on mortality in patients admitted to the ICU requiring MV for ARF due to non-cardiac reasons. Patients with diastolic dysfunction in addition to their known systolic dysfunction, as expected, had worse overall outcomes; there was an increase in hospital mortality in these patients compared with subjects without CHF. Although no major differences in outcomes were noted between HFrEF or HFpEF vs controls or HFrEF vs HFpEF, limited sample size may be masking important differences among these groups.
Author Block: H. Mehta1, A. Vaidya1, C. Janick1, J. A. Weingarten2, R. Minkin1; 1Pulmonary, Critical Care and Sleep Medicine Division, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, United States, 2Pulmonary, Critical Care and Sleep Division, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, United States.
Introduction: Among patients admitted to the intensive care unit (ICU) for acute respiratory failure (ARF), approximately 30% require mechanical ventilation (MV). As significant numbers of these patients have congestive heart failure (CHF), clinicians need a better understanding of interactions between these diagnoses. The aim of this study was to determine ICU and hospital mortality among patients admitted for ARF due to non-cardiac reasons requiring MV. Subgroups of CHF, including heart failure with reduced ejection fraction (HFrEF), preserved ejection fraction (HFpEF), or combined systolic-diastolic CHF (CSDHF) were examined.
Methods: Single center, retrospective analysis of subjects requiring MV for ARF within a 3-year period. Subjects were selected based on ICD-9 codes. Medical records were reviewed to confirm diagnoses. Baseline characteristics including co-morbidities, echocardiogram results, ICU length of stay (LOS), hospital LOS, and all-cause ICU and hospital mortality were analyzed.
Results: 151 patients were identified, 78 (51.7%) with evidence of CHF: 28 (18.5%) subjects had HFrEF, 50 (33.1%) had HFpEF, and 13 (8.61%) had CSDHF. The mean (± SD) age was 70.1 ± 14.1. Mean ICU length of stay LOS (± SD) was 7.1 ± 10.3 days and mean hospital LOS (± SD) was 17.5 ± 21.7 days. There was an increased risk of hospital mortality among those with CSDHF compared with controls (69% vs 37%, p=0.03). There was a trend (p=0.054) towards increased risk of ICU death among those with CSDHF compared with controls. There were no significant differences in ICU or hospital mortality comparing either HFrEF or HFpEF vs controls, or HFrEF vs HFpEF.
Discussion: This retrospective analysis highlights the impact of comorbid heart failure on mortality in patients admitted to the ICU requiring MV for ARF due to non-cardiac reasons. Patients with diastolic dysfunction in addition to their known systolic dysfunction, as expected, had worse overall outcomes; there was an increase in hospital mortality in these patients compared with subjects without CHF. Although no major differences in outcomes were noted between HFrEF or HFpEF vs controls or HFrEF vs HFpEF, limited sample size may be masking important differences among these groups.
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