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.
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Article info
Publication history
Published online: September 06, 2019
Received in revised form:
August 10,
2019
Received:
May 2,
2019
Footnotes
Funding: None.
Identification
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© 2019 Elsevier Inc. All rights reserved.
