Association between Respiratory Failure and Clinical Outcomes in Patients with Acute Heart Failure: Analysis of 5 Pooled Clinical Trials.

Abstract Background 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 (MV). Methods After pooling 5 acute HF clinical trials, we utilized multivariable logistic regression adjusted for demographics, comorbidities, exam, and laboratory findings to assess associations between MV and clinical outcomes. Results Among the 8,296 patients, 210 (2.5%) required MV. Age, gender, smoking history, baseline ejection fraction, heart failure 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 MV 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 0.20). Conclusions 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.