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.
Original language | English (US) |
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Article number | e78222 |
Journal | PloS one |
Volume | 8 |
Issue number | 10 |
DOIs | |
State | Published - Oct 21 2013 |
Funding
Dr. Krumholz reports that he is the recipient of a research grant from Medtronic, Inc. through Yale University and is chair of a cardiac scientific advisory board for UnitedHealth. The authors declare that no other competing interests exist. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.
ASJC Scopus subject areas
- General
- General Biochemistry, Genetics and Molecular Biology
- General Agricultural and Biological Sciences