National Trends in Incidence and Outcomes of Patients With Heart Failure Requiring Respiratory Support.

Published on Dec 1, 2019in American Journal of Cardiology2.778
路 DOI :10.1016/J.AMJCARD.2019.08.033
P. Elliott Miller15
Estimated H-index: 15
(Yale University),
Shanti Patel16
Estimated H-index: 16
(Maimonides Medical Center)
+ 12 AuthorsNihar R. Desai26
Estimated H-index: 26
(Yale University)
Sources
Abstract
Abstract Despite increasing medical complexity in patients with heart failure (HF), there are limited data on incidence and outcomes for patients with HF needing respiratory support. This study sought to examine contemporary trends of respiratory support strategies among patients with HF. Using the National Inpatient Sample, we identified adults aged greater than 18 years hospitalized with a primary diagnosis of HF. We assessed for trends in the use of invasive mechanical ventilation (IMV) and non-invasive ventilation (NIV), length of stay (LOS), hospital costs, and in-hospital mortality. From 2002-2014, we identified 9,508,768 HF hospitalizations, which included 202,340 (2.13%) and 257,549 (2.71%) patients that required IMV and NIV, respectively. Over the study period, the proportion of HF patients requiring IMV significantly decreased (3.25% in 2002 to 1.56% in 2014) while the use of NIV significantly increased from 0.95% to 7.25% (ptrend
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#1P. Elliott Miller (Yale University)H-Index: 15
#2Sean van Diepen (U of A: University of Alberta)H-Index: 31
Last. Tariq Ahmad (Yale University)H-Index: 72
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#1Carlos L. Alviar (UF: University of Florida)H-Index: 16
#2P. Elliott MillerH-Index: 15
Last. David A. MorrowH-Index: 127
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Abstract Contemporary cardiac intensive care units (CICUs) provide care for an aging and increasingly complex patient population. The medical complexity of this population is partly driven by an increased proportion of patients with respiratory failure needing noninvasive or invasive positive pressure ventilation (PPV). PPV often plays an important role in the management of patients with cardiogenic pulmonary edema, cardiogenic shock, or cardiac arrest, and those undergoing mechanical circulator...
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#1Abhinav Sharma (Stanford University)H-Index: 21
#2Xin Zhao (Duke University)H-Index: 28
Last. Adam D. DeVore (Duke University)H-Index: 30
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Background:The increase in medical complexity among patients hospitalized with heart failure (HF) may be reflected by an increase in concomitant noncardiovascular comorbidities. Among patients hosp...
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#1Shashank S. Sinha (UM: University of Michigan)H-Index: 13
#2Michael W. SjodingH-Index: 19
Last. Brahmajee K. NallamothuH-Index: 89
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Background鈥擡arly reports suggest the number of cardiac intensive care unit (CICU) patients with primary noncardiac diagnoses is rising in the United States, but no national data currently exist. We examined changes in primary noncardiac diagnoses among elderly patients admitted to a CICU during the past decade. Methods and Results鈥擴sing 2003 to 2013 Medicare data, we grouped elderly patients admitted to CICUs into 2 categories based on principal diagnosis at discharge: (1) primary noncardiac dia...
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#1Eric M Holland (University of Virginia Health System)H-Index: 4
#2Travis J. Moss (University of Virginia Health System)H-Index: 10
Abstract Background Fifty years after the inception of the cardiac intensive care unit (CICU), noncardiovascular illnesses have become more prevalent and may contribute to morbidity and mortality. Objectives The authors performed multivariate statistical analyses to determine the association of acute noncardiovascular illnesses with outcomes, including length of stay (LOS), mortality, and hospital readmission. Methods We studied 1,042 admissions between October 12, 2013 and November 28, 2014 to ...
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#1Thomas S. Metkus (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 15
#2Aiham Albaeni (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 7
Last. Shaker M. Eid (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 14
view all 4 authors...
Data addressing the use of respiratory support in acute coronary syndromes are lacking. To address this evidence gap, we characterized prognostic impact and trends in utilization of invasive mechanical ventilation (IMV) and noninvasive ventilation (NIV) in patients hospitalized with ST-segment elevation myocardial infarction (STEMI) from 2002 through 2013 using the National Inpatient Sample. Multivariate logistic regression was performed to identify patient, hospital, and clinical characteristic...
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#1Rohan Khera (UTSW: University of Texas Southwestern Medical Center)H-Index: 29
#2Ambarish Pandey (UTSW: University of Texas Southwestern Medical Center)H-Index: 45
Last. Gregg C. Fonarow (UCLA: University of California, Los Angeles)H-Index: 180
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Background鈥 There has been an increase in the use of pulmonary artery (PA) catheters in heart failure (HF) in the United States in recent years. However, patterns of hospital use and trends in patient outcomes are not known. Methods and Results鈥 In the National Inpatient Sample 2001 to 2012, using International Classification of Diseases -Ninth Revision codes, we identified 11鈥888鈥525 adult (鈮18 years) HF hospitalizations nationally, of which an estimated 75鈥209 (SE 0.6%) received a PA catheter....
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ACC/AHA : American College of Cardiology/American Heart Association ACCF/AHA : American College of Cardiology Foundation/American Heart Association ACE : angiotensin-converting enzyme ACEI : angiotensin-converting enzyme inhibitor ACS : acute coronary syndrome AF : atrial fibrillation
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#1Parag Goyal (Cornell University)H-Index: 25
#2Zaid Almarzooq (Cornell University)H-Index: 9
Last. Luke K. Kim (Cornell University)H-Index: 22
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Abstract Background Hospitalizations for heart failure with preserved ejection fraction (HFpEF) are increasing. There are limited data examining national trends in patients hospitalized with HFpEF. Methods Using the Nationwide Inpatient Sample, we examined 5,046,879 hospitalizations with a diagnosis of acute heart failure in 2003-2012, stratifying hospitalizations by HFpEF and heart failure with reduced ejection fraction (HFrEF). Patient and hospital characteristics, in-hospital mortality, and l...
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Cited By9
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#1P. Elliott Miller (Yale University)H-Index: 15
#2Clancy W. Mullan (Yale University)H-Index: 6
Last. Richard N. Formica (Yale University)H-Index: 23
view all 13 authors...
AIMS The impact of mechanical ventilation (MV) at the time of heart transplantation is not well understood. In addition, MV was recently removed as a criterion from the new US heart transplantation allocation system. We sought to assess for the association between MV at transplantation and 1-year mortality. METHODS AND RESULTS We utilized the United Network for Organ Sharing database and included all adult, single organ heart transplantations from 1990 to 2019. We utilized multivariable logistic...
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#1P. Elliott Miller (Yale University)H-Index: 15
#2Alexander Thomas (Yale University)H-Index: 2
Last. Jacob C. Jentzer (Mayo Clinic)H-Index: 25
view all 13 authors...
BACKGROUND Current cardiac intensive care unit (CICU) practice has seen an increase in patient complexity, including an increase in noncardiac organ failure, critical care therapies, and comorbidities. We sought to describe the changing epidemiology of noncardiac multimorbidity in the CICU population. METHODS We analyzed consecutive unique patient admissions to 2 geographically distant tertiary care CICUs (n聽=聽16,390). We assessed for the prevalence of 0, 1, 2, and 鈮3 noncardiac comorbidities (d...
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#1Jacob C. Jentzer (Mayo Clinic)H-Index: 25
#2Carlos L. Alviar (NYU: New York University)H-Index: 16
Last. Ognjen Gajic (Mayo Clinic)H-Index: 72
view all 9 authors...
Purpose:To describe the epidemiology, outcomes, and temporal trends of respiratory failure in the cardiac intensive care unit (CICU).Materials and Methods:Retrospective cohort analysis of 2,986 uni...
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#1P. Elliott Miller (Yale University)H-Index: 15
#2Sean van Diepen (U of A: University of Alberta)H-Index: 31
Last. Tariq Ahmad (Yale University)H-Index: 72
view all 10 authors...
Abstract Background Despite a temporal increase in respiratory failure in patients hospitalized with acute heart failure (HF), clinical trials have largely not reported the incidence or associated clinical outcomes for patients requiring mechanical ventilation (MV). Methods After pooling 5 acute HF clinical trials, we utilized multivariable logistic regression adjusted for demographics, comorbidities, exam, and laboratory findings to assess associations between MV and clinical outcomes. Results ...
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#1Thomas S. Metkus (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 15
#2P. Elliott Miller (Yale University)H-Index: 15
Last. Michael C. Kontos (VCU: Virginia Commonwealth University)H-Index: 32
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The medical complexity and critical care needs of patients admitted to cardiac ICUs are increasing, and prospective studies examining the underlying cardiac and noncardiac diagnoses, the management strategies, and the prognosis of cardiac ICU patients with respiratory failure are needed. Design Prospective cohort study. Setting The Critical Care Cardiology Trials Network is a research collaborative of cardiac ICUs across the United States and Canada. Patients We included all medical cardiac ICU ...
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#1Javier de Miguel-D铆ez (Hospital General Universitario Gregorio Mara帽贸n)H-Index: 18
#2Rodrigo Jim茅nez-Garc铆a (Complutense University of Madrid)H-Index: 35
Last. Ana L贸pez-de-Andr茅sH-Index: 18
view all 9 authors...
BACKGROUND: We evaluated seventeen years' trends (2001-2017) in the utilization of non-invasive ventilation (NIV), invasive mechanical ventilation (IMV) or both types of ventilator support (NIV+IMV) among patients hospitalized for heart failure (HF). METHODS: Observational retrospective epidemiological study using the Spanish National Hospital Discharge Database. RESULTS: Over a total of 3,634,044 HF hospitalized patients, we identified 164,815 who were treated with ventilator support. 70.5% rec...
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