Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut; Yale National Clinicians Scholar Program, New Haven, Connecticut.
Department of Critical Care and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
J Card Fail. 2021 May;27(5):602-606. doi: 10.1016/j.cardfail.2021.01.018. Epub 2021 Feb 5.
Despite a temporal increase in respiratory failure in patients hospitalized with acute heart failure (HF), clinical trials have largely not reported the incidence or associated clinical outcomes for patients requiring mechanical ventilation.
After pooling 5 acute HF clinical trials, we used multivariable logistic regression adjusted for demographics, comorbidities, examinations, and laboratory findings to assess associations between mechanical ventilation and clinical outcomes. Among the 8296 patients, 210 (2.5%) required mechanical ventilation. Age, sex, smoking history, baseline ejection fraction, HF etiology, and the proportion of patients randomized to treatment or placebo in the original clinical trial were similar between groups (all, P > 0.05). Baseline diabetes mellitus was more common in the mechanical ventilation group (P = 0.02), but other comorbidities, including chronic lung disease, were otherwise similar (all P > 0.05). HF rehospitalization at 30 days (12.7% vs 6.6%, P < 0.001) and all-cause 60-day mortality (33.3% vs 6.1%, P < 0.001) was higher among patients requiring mechanical ventilation. After multivariable adjustment, mechanical ventilation use was associated with an increased 30-day HF rehospitalization (odds ratio 2.03; 95% confidence interval, 1.29-3.21, P = 0.002), 30-day mortality (odds ratio 10.40; 95% confidence interval, 7.22-14.98, P < 0.001), and 60-day mortality (odds ratio 7.68; 95% confidence interval, 5.50-10.74, P < 0.001). The influence of mechanical ventilation did not differ by HF etiology or baseline ejection fraction (both, interaction P > 0.20).
Respiratory failure during an index hospitalization for acute HF was associated with increased rehospitalization and all-cause mortality. The development of respiratory failure during an acute HF admission identifies a particularly vulnerable population, which should be identified for closer monitoring.
尽管因急性心力衰竭（HF）住院的患者发生呼吸衰竭的时间有所增加，但临床试验并未大量报告需要机械通气的患者的发病率或相关临床结局。
在汇集了 5 项急性 HF 临床试验后，我们使用多变量逻辑回归调整了人口统计学、合并症、检查和实验室发现，以评估机械通气与临床结局之间的关联。在 8296 名患者中，有 210 名（2.5%）需要机械通气。两组间年龄、性别、吸烟史、基线射血分数、HF 病因以及原始临床试验中随机分配至治疗或安慰剂的患者比例均相似（均 P > 0.05）。机械通气组基线时糖尿病更为常见（P=0.02），但其他合并症（包括慢性肺部疾病）则相似（均 P > 0.05）。机械通气组 30 天 HF 再入院率（12.7%比 6.6%，P < 0.001）和全因 60 天死亡率（33.3%比 6.1%，P < 0.001）更高。多变量调整后，机械通气的使用与 30 天 HF 再入院率（优势比 2.03；95%置信区间，1.29-3.21，P=0.002）、30 天死亡率（优势比 10.40；95%置信区间，7.22-14.98，P < 0.001）和 60 天死亡率（优势比 7.68；95%置信区间，5.50-10.74，P < 0.001）增加相关。机械通气的影响不因 HF 病因或基线射血分数而异（两者交互 P > 0.20）。
急性 HF 住院期间发生呼吸衰竭与再入院和全因死亡率增加相关。急性 HF 入院期间发生呼吸衰竭可识别出一个特别脆弱的人群，应加强监测。
