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Acute decompensated heart failure is routinely treated as a cardiopulmonary syndrome.

Dharmarajan K, Strait KM, Lagu T, Lindenauer PK, Tinetti ME, Lynn J, Li SX, Krumholz HM - PLoS ONE (2013)

Bottom Line: We focused on the receipt of medications appropriate for other acute conditions associated with shortness of breath including acute asthma, pneumonia, and exacerbated chronic obstructive pulmonary disease.We also calculated adjusted odds of in-hospital death, admission to the intensive care unit, and late intubation (intubation after hospital day 2).Respiratory treatment was more frequent among the 60,690 hospitalizations with chronic lung disease.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Columbia University Medical Center, New York, New York, United States of America ; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, United States of America.

ABSTRACT

Background: Heart failure as recognized and treated in typical practice may represent a complex condition that defies discrete categorizations. To illuminate this complexity, we examined treatment strategies for patients hospitalized and treated for decompensated heart failure. We focused on the receipt of medications appropriate for other acute conditions associated with shortness of breath including acute asthma, pneumonia, and exacerbated chronic obstructive pulmonary disease.

Methods and results: Using Premier Perspective(®), we studied adults hospitalized with a principal discharge diagnosis of heart failure and evidence of acute heart failure treatment from 2009-2010 at 370 US hospitals. We determined treatment with acute respiratory therapies during the initial 2 days of hospitalization and daily during hospital days 3-5. We also calculated adjusted odds of in-hospital death, admission to the intensive care unit, and late intubation (intubation after hospital day 2). Among 164,494 heart failure hospitalizations, 53% received acute respiratory therapies during the first 2 hospital days: 37% received short-acting inhaled bronchodilators, 33% received antibiotics, and 10% received high-dose corticosteroids. Of these 87,319 hospitalizations, over 60% continued receiving respiratory therapies after hospital day 2. Respiratory treatment was more frequent among the 60,690 hospitalizations with chronic lung disease. Treatment with acute respiratory therapy during the first 2 hospital days was associated with higher adjusted odds of all adverse outcomes.

Conclusions: Acute respiratory therapy is administered to more than half of patients hospitalized with and treated for decompensated heart failure. Heart failure is therefore regularly treated as a broader cardiopulmonary syndrome rather than as a singular cardiac condition.

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Related in: MedlinePlus

Proportion of hospitalizations receiving short-acting inhaled bronchodilators, antibiotics, and high-dose corticosteroids during the first 2 hospital days and hospital days 3 through 5.Figure A shows results for all heart failure hospitalizations (n=164,494). Figure B shows results for heart failure hospitalizations with chronic lung disease (n=60,690).HF, heart failure.
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pone-0078222-g002: Proportion of hospitalizations receiving short-acting inhaled bronchodilators, antibiotics, and high-dose corticosteroids during the first 2 hospital days and hospital days 3 through 5.Figure A shows results for all heart failure hospitalizations (n=164,494). Figure B shows results for heart failure hospitalizations with chronic lung disease (n=60,690).HF, heart failure.

Mentions: Treatment with short-acting inhaled bronchodilators and antibiotics was particularly frequent. Among the cohort of all heart failure hospitalizations, 37% and 30% received treatment with short-acting inhaled bronchodilators during the first 2 hospital days and hospital days 3 through 5, respectively (Figure 2A). Among the subset with chronic lung disease, 59% and 50% received treatment with short-acting inhaled bronchodilators during the first 2 hospital days and hospital days 3 through 5, respectively (Figure 2B). Inhaled beta agonists were the most frequently used agents in both cohorts during both time periods (Table S3 in File S1). Analogously, among the cohort of all heart failure hospitalizations, approximately one-third received antibiotics during both time periods (Figure 2A). Among heart failure hospitalizations with chronic lung disease, 42% received antibiotics during both time periods (Figure 2B). The most commonly used antibiotic pharmacologic classes were fluoroquinolones and cephalosporins in both cohorts during both time periods (Table S3 in File S1). Although corticosteroids were the least frequently used of all studied acute respiratory therapies, we did find that 17% of hospitalizations with chronic lung disease received high-dose corticosteroids during the first 2 hospital days (Table S3 in File S1).


Acute decompensated heart failure is routinely treated as a cardiopulmonary syndrome.

Dharmarajan K, Strait KM, Lagu T, Lindenauer PK, Tinetti ME, Lynn J, Li SX, Krumholz HM - PLoS ONE (2013)

Proportion of hospitalizations receiving short-acting inhaled bronchodilators, antibiotics, and high-dose corticosteroids during the first 2 hospital days and hospital days 3 through 5.Figure A shows results for all heart failure hospitalizations (n=164,494). Figure B shows results for heart failure hospitalizations with chronic lung disease (n=60,690).HF, heart failure.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3824040&req=5

pone-0078222-g002: Proportion of hospitalizations receiving short-acting inhaled bronchodilators, antibiotics, and high-dose corticosteroids during the first 2 hospital days and hospital days 3 through 5.Figure A shows results for all heart failure hospitalizations (n=164,494). Figure B shows results for heart failure hospitalizations with chronic lung disease (n=60,690).HF, heart failure.
Mentions: Treatment with short-acting inhaled bronchodilators and antibiotics was particularly frequent. Among the cohort of all heart failure hospitalizations, 37% and 30% received treatment with short-acting inhaled bronchodilators during the first 2 hospital days and hospital days 3 through 5, respectively (Figure 2A). Among the subset with chronic lung disease, 59% and 50% received treatment with short-acting inhaled bronchodilators during the first 2 hospital days and hospital days 3 through 5, respectively (Figure 2B). Inhaled beta agonists were the most frequently used agents in both cohorts during both time periods (Table S3 in File S1). Analogously, among the cohort of all heart failure hospitalizations, approximately one-third received antibiotics during both time periods (Figure 2A). Among heart failure hospitalizations with chronic lung disease, 42% received antibiotics during both time periods (Figure 2B). The most commonly used antibiotic pharmacologic classes were fluoroquinolones and cephalosporins in both cohorts during both time periods (Table S3 in File S1). Although corticosteroids were the least frequently used of all studied acute respiratory therapies, we did find that 17% of hospitalizations with chronic lung disease received high-dose corticosteroids during the first 2 hospital days (Table S3 in File S1).

Bottom Line: We focused on the receipt of medications appropriate for other acute conditions associated with shortness of breath including acute asthma, pneumonia, and exacerbated chronic obstructive pulmonary disease.We also calculated adjusted odds of in-hospital death, admission to the intensive care unit, and late intubation (intubation after hospital day 2).Respiratory treatment was more frequent among the 60,690 hospitalizations with chronic lung disease.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Columbia University Medical Center, New York, New York, United States of America ; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, United States of America.

ABSTRACT

Background: Heart failure as recognized and treated in typical practice may represent a complex condition that defies discrete categorizations. To illuminate this complexity, we examined treatment strategies for patients hospitalized and treated for decompensated heart failure. We focused on the receipt of medications appropriate for other acute conditions associated with shortness of breath including acute asthma, pneumonia, and exacerbated chronic obstructive pulmonary disease.

Methods and results: Using Premier Perspective(®), we studied adults hospitalized with a principal discharge diagnosis of heart failure and evidence of acute heart failure treatment from 2009-2010 at 370 US hospitals. We determined treatment with acute respiratory therapies during the initial 2 days of hospitalization and daily during hospital days 3-5. We also calculated adjusted odds of in-hospital death, admission to the intensive care unit, and late intubation (intubation after hospital day 2). Among 164,494 heart failure hospitalizations, 53% received acute respiratory therapies during the first 2 hospital days: 37% received short-acting inhaled bronchodilators, 33% received antibiotics, and 10% received high-dose corticosteroids. Of these 87,319 hospitalizations, over 60% continued receiving respiratory therapies after hospital day 2. Respiratory treatment was more frequent among the 60,690 hospitalizations with chronic lung disease. Treatment with acute respiratory therapy during the first 2 hospital days was associated with higher adjusted odds of all adverse outcomes.

Conclusions: Acute respiratory therapy is administered to more than half of patients hospitalized with and treated for decompensated heart failure. Heart failure is therefore regularly treated as a broader cardiopulmonary syndrome rather than as a singular cardiac condition.

Show MeSH
Related in: MedlinePlus