Presentation and outcome of critically ill medical and cardiac-surgery patients with acute heart failure.

Abstract

The aim of the study was to investigate presentation and outcome of consecutive acute heart failure (AHF) patients admitted to the intensive care unit (ICU) including also patients undergoing cardiac surgery, thereby providing comparative information on all critically ill AHF subgroups. The prospective observational study with 6-month follow up was performed in the cardio-thoracic and the medical ICU of a university hospital. AHF was defined according to the European Society of Cardiology guidelines. Univariate Cox regression was used to calculate hazard ratio (HR) and 95% confidence intervals (CI) for risk factors. A total of 192 patients fulfilled the AHF criteria, of whom 86 and 24 underwent elective and emergency cardiac surgery, respectively. The remaining 82 medical patients had no surgical interventions. Cardiogenic shock was diagnosed in 32% of all patients and was the most common AHF presentation. Medical, elective surgery and emergency surgery AHF patients had a mortality at 30 days of 31%, 4.7% and 22% (<0.05) and at 180 days of 42%, 6.1% and 23% (<0.05), respectively. While the presence of cardiogenic shock was associated with a poor outcome (HR 1.8, CI 1.0-3.0; p=0.04), post-operative cardiac stunning had a good prognosis (HR 0.06, CI 0.01-0.47; p<0.01). Mortality worsened when infections (HR 2.8, CI 1.5-5.7; p<0.01) or renal dysfunction (HR 4.4, CI 2.2-8.4, p<0.01) were present on ICU admission. Medical patients, patients undergoing elective cardiac surgery and patients requiring emergency cardiac surgery are three distinct AHF-subpopulations. Co-morbidities and surgical treatment options affect long-term outcome.