Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.
Department of Internal Medicine, Maimonides Medical Center, Brooklyn, New York.
Am J Cardiol. 2019 Dec 1;124(11):1712-1719. doi: 10.1016/j.amjcard.2019.08.033. Epub 2019 Sep 6.
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% (p <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%, p <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, p <0.001) and doubled for those requiring NIV ($37,539 in 2014, p <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.
尽管心力衰竭（HF）患者的医疗复杂性不断增加，但需要呼吸支持的 HF 患者的发病率和结局数据有限。本研究旨在探讨 HF 患者呼吸支持策略的当代趋势。我们使用国家住院患者样本，确定了年龄大于 18 岁、因主要诊断为 HF 住院的成年人。我们评估了有创机械通气（IMV）和无创通气（NIV）、住院时间、住院费用和院内死亡率的使用趋势。从 2002 年到 2014 年，我们确定了 9508768 例 HF 住院患者，其中 202340（2.13%）和 257549（2.71%）例患者分别需要 IMV 和 NIV。在研究期间，需要 IMV 的 HF 患者比例显著下降（2002 年为 3.25%，2014 年为 1.56%），而 NIV 的使用比例从 0.95%显著增加到 7.25%（均<0.001）。需要 IMV 的患者的院内死亡率显著增加（2002 年为 31.5%，2014 年为 38.6%），而需要 NIV 的患者的死亡率下降（9.0%至 5.6%，均<0.0001）。需要 IMV 的患者的平均住院时间长近 7 天（12.2 天），需要 NIV 的患者长 2 天（6.8 天；均<0.001）。需要 IMV 的患者的住院费用几乎翻了三倍（2014 年为 99358 美元，<0.001），需要 NIV 的患者的住院费用增加了一倍（2014 年为 37539 美元，<0.001）。总之，与 IMV 相比，HF 患者呼吸支持策略的使用显著增加，NIV 的使用不断增加。然而，与呼吸衰竭相关的院内死亡率仍然高得令人无法接受。
