Abstract 254: Utilization and Outcomes of Early Respiratory Support in 6.5 Million Acute Heart Failure Hospitalizations

Abstract

Background: Patients with acute heart failure (AHF) often require non-invasive ventilation (NIV) via facemask or invasive mechanical ventilation (IMV) via endotracheal tube, yet the incidence and prognostic connotation of IMV and NIV use in AHF are not well established. Methods: We used the National Inpatient Sample (NIS), a US database of hospital admissions. Using ICD-9 codes, we identified all patients admitted with AHF between 2008 and 2014. The exposure variable was IMV or NIV use compared to no respiratory support. We analyzed the association between ventilation strategies and in-hospital mortality using Cox proportional hazards models. Results: We included 6,534,675 hospitalizations for AHF. Of these, 271,589 (4.16%) included NIV and 51,459 (0.79%) included IMV within the first 24 hours of hospitalization. Rates of NIV and IMV use increased over time [Fig 1]. In-hospital mortality for AHF patients treated with NIV was 5.0% and 27% for those treated with IMV. In an adjusted model, requirement for NIV was associated with over 2 fold higher risk for in-hospital mortality compared to no respiratory support (HR 2.10, 95% CI 2.01-2.19, P<0.001) and requirement for IMV was associated with over 3 fold higher risk for in hospital mortality (HR 3.39, 95% CI 3.14-3.66, P<0.001) [Fig 2]. Conclusion: Respiratory support is used in many AHF hospitalizations, and AHF patients who require respiratory support are at high risk for in-hospital mortality. Our work should inform prospective intervention trials and quality improvement ventures in this high-risk population.