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

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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 noninvasive ventilation (NIV), length of stay, hospital costs, and in-hospital mortality. From 2002 to 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) whereas the use of NIV significantly increased from 0.95% to 7.25% (ptrend <0.001 for both). In-hospital mortality significantly increased for IMV (31.5% in 2002 to 38.6% in 2014) recipients and decreased for patients requiring NIV (9.0% to 5.6%, ptrend <0.0001 for both). The average length of stay was nearly 7 days longer in the IMV group (12.2 days) and 2 days longer in the NIV group (6.8 days; p <0.001 for both). Hospital charges have nearly tripled for patients requiring IMV ($99,358 in 2014, ptrend <0.001) and doubled for those requiring NIV ($37,539 in 2014, ptrend <0.001). In conclusion, respiratory support strategies for patients with HF have significantly evolved with increasing use of NIV as compared with IMV. However, the in-hospital mortality associated with respiratory failure remains unacceptably high.

Section snippets

Methods

We obtained data from 2002 through 2014 from the NIS database, which was developed by the Healthcare Cost and Utilization Project (HCUP).6 As previously described, the NIS is the largest, publicly available all-payer inpatient database in the United States. It includes a 20% stratified sample of inpatient hospitalizations (excluding observation status and psychiatric hospitals) as well as all procedural and International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)

Results

From 2002 to 2014, we identified 9,508,768 hospitalizations with a primary diagnosis of HF, which included 202,340 (2.13%) and 257,549 (2.71%) hospitalizations that required either IMV or NIV, respectively (Table 1). Compared with a mean (Ā±SE) age of 72.0 (Ā±0.1) years for those not requiring respiratory support, recipients of IMV and NIV were younger with a mean age of 70.0 (Ā±0.1) and 70.9 (Ā±0.1) years (p <0.0001 for both). Recipients of IMV and NIV were more likely to be black or Hispanic and

Discussion

In this national study of patients hospitalized with HF from 2002 through 2014, we found that nearly 5% of HF hospitalizations required the use of respiratory support. Over the study period, there was a significant change in ventilator strategy utilization with an increase in NIV and decrease in IMV. Among those requiring IMV, the in-hospital mortality was nearly 40%. Mortality among NIV recipients improved whereas cost increased significantly for both types of respiratory support. These

Disclosures

The authors have no conflicts of interest to disclose.

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    Funding: None.

    1

    These authors contributed equally to this work.

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