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National trends in mechanical ventilation among patients hospitalized with heart failure: a population-based study in Spain (2001-2017)

Published:April 20, 2020DOI:https://doi.org/10.1016/j.ejim.2020.04.016

      Highlights

      • We assessed 17 years trends in ventilator support among patients with heart failure.
      • Beside type of ventilator support the clinical profile of patients worsen over time.
      • Over time the use of noninvasive ventilation (NIV) increased significantly.
      • From 2001 to 2017 the use of invasive mechanical ventilation (IMV) decreased.
      • In hospital mortality decreased over time for NIV, NIV+IMM and was stable for IMV.

      ABSTRACT

      Background

      We evaluated seventeen years’ trends (2001-2017) in the utilization of non-invasive ventilation (NIV), invasive mechanical ventilation (IMV) or both types of ventilator support (NIV+IMV) among patients hospitalized for heart failure (HF).

      Methods

      Observational retrospective epidemiological study using the Spanish National Hospital Discharge Database.

      Results

      Over a total of 3,634,044 HF hospitalized patients, we identified 164,815 who were treated with ventilator support. 70.5% received NIV, 24.9% IMV and 4.6% both procedures. Patients receiving NIV were the oldest and had the highest mean value for Charlson comorbidity index (CCI) score. For all types of ventilation values of CCI≥3 increased significantly over the study period (all p<0.001). Patients who received IMV had the highest IHM (48.1%) followed by those with NIV+IMV (44.7%) and NIV (19.9%). The in hospital mortality (IHM) decreased significantly in patients with NIV+IMV and NIV and remained stable in those with IMV. Compared to admissions without ventilation, the probability of receiving NIV and NIV+IMV increased significantly over time, however IMV decreased significantly. Factors associated with a greater probability of receiving NIV vs not being ventilated included higher age, higher CCI and suffering pneumonia whereas male sex reduced the probability. For IMV and NIV+IMV the factors are the same than for NIV, except male sex that increased the probability for IMV and NIV+IMV.

      Conclusions

      We found a significant change in ventilator strategy in hospitalized HF patients over time. Even if the clinical profile is worsening IHM decreased significantly over time, but only in HF patients who received NIV and NIV+IMV.

      Keywords

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