Association of Non-Invasive Positive Pressure Ventilation with Short-Term Clinical Outcomes in Patients Hospitalized for Acute Decompensated Heart Failure.

Midori Yukino,Ayumi Goda,Takashi Kohno,Yosuke Nishihata,Makoto Takei,Yukinori Ikegami,Yuichi Toyosaki,Yasuyuki Shiraishi,Shun Kohsaka,Takeshi Adachi,Shintaro Nakano,Mike Saji,Yuji Nagatomo,Tsutomu Yoshikawa

doi:10.3390/jcm10215092

Abstract

The real-world evidence has been sparse on the impact of non-invasive positive pressure ventilation (NPPV) on the outcomes in acute decompensated heart failure (ADHF) patients. We aim to explore this issue in the prospective multicenter WET-HF registry. Among 3927 patients (77 (67–84) years, male 60%), the NPPV was used in 775 patients (19.7%). The association of NPPV use with in-hospital outcome and length of hospital stay (LOS) was examined by two methods, propensity score (PS) matching and multivariable analysis with adjustment for PS. In these analyses the NPPV group exhibited a lower endotracheal intubation (ETI) rate and a comparable in-hospital mortality, but longer LOS compared to the non-NPPV group. In the stratified analysis, the NPPV group exhibited a significantly lower ETI rate in patients with ischemic etiology, systolic blood pressure (sBP) > 140 mmHg and the Controlling Nutritional Status (CONUT) score ≤ 3, indicating better nutritional status. On the contrary, NPPV use was associated with longer LOS in patients with non-ischemic etiology, sBP < 100 mmHg and CONUT score > 3. In conclusion, NPPV use was associated with a lower incidence of ETI. Particularly, patients with ischemic etiology, high sBP, and better nutritional status might benefit from NPPV use.

Highlights

Heart failure (HF) is a major social problem that has been increasing in prevalence worldwide due to a rapidly aging society [1]
We demonstrated the following main findings: (1) In the postmatched cohort, Non-invasive positive pressure ventilation (NPPV) use was associated with a lower endotracheal intubation (ETI) rate, but there were no differences in in-hospital mortality during admission
(3) NPPV use was associated with a lower ETI rate in some subgroups such as patients with ischemic etiology, systolic blood pressure (sBP) > 140 mmHg at admission, left ventricular ejection fraction (LVEF) < 50%, and better nutritional status indicated by Controlling Nutritional Status (CONUT) score ≤ 3

Summary

Introduction

Heart failure (HF) is a major social problem that has been increasing in prevalence worldwide due to a rapidly aging society [1]. The current pathophysiologic understanding of acute decompensated HF (ADHF) is incomplete. Non-invasive positive pressure ventilation (NPPV) has been used to treat acute exacerbations of chronic respiratory diseases instead of traditional endotracheal intubation (ETI) since 1990 [3]. Over the past two decades, NPPV has been increasingly used in patients with acute cardiogenic pulmonary edema (ACPE) [4]. NPPV improves oxygenation, decreases breathing effort [4], and reduces left ventricular afterload [4] and both right and left ventricular preload [5] in patients with ACPE. Prompt improvement in patient-reported dyspnea, acidosis, hypercapnia, and tachycardia has been consistently reported after NPPV use [6]

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