Key result
Non-invasive positive pressure ventilation was associated with a lower rate of endotracheal intubation (RR 0.515 in propensity-matched analysis) and comparable in-hospital mortality in ADHF.
Why the study?
Real-world evidence has been sparse regarding the impact of non-invasive positive pressure ventilation on outcomes in acute decompensated heart failure patients.
Does non-invasive positive pressure ventilation (NPPV) reduce endotracheal intubation, in-hospital mortality, and length of hospital stay in patients hospitalized for acute decompensated heart failure?
Cohort (n=3,927)
Yes
Does non-invasive positive pressure ventilation (NPPV) reduce endotracheal intubation, in-hospital mortality, and length of hospital stay in patients hospitalized for acute decompensated heart failure?
Answers are grounded in this paper and cite their sources.
In real-world patients hospitalized with acute decompensated heart failure, non-invasive positive pressure ventilation is associated with reduced endotracheal intubation rates without altering in-hospital mortality, particularly benefiting those with ischemic etiology, systolic blood pressure >140 mmHg, and preserved nutritional status.
The real-world evidence has been sparse on the impact of non-invasive positive pressure ventilation (NPPV) on the outcomes in acute decompensated heart failure (ADHF) patients. We aim to explore this issue in the prospective multicenter WET-HF registry. Among 3927 patients (77 (67-84) years, male 60%), the NPPV was used in 775 patients (19.7%). The association of NPPV use with in-hospital outcome and length of hospital stay (LOS) was examined by two methods, propensity score (PS) matching and multivariable analysis with adjustment for PS. In these analyses the NPPV group exhibited a lower endotracheal intubation (ETI) rate and a comparable in-hospital mortality, but longer LOS compared to the non-NPPV group. In the stratified analysis, the NPPV group exhibited a significantly lower ETI rate in patients with ischemic etiology, systolic blood pressure (sBP) > 140 mmHg and the Controlling Nutritional Status (CONUT) score ≤ 3, indicating better nutritional status. On the contrary, NPPV use was associated with longer LOS in patients with non-ischemic etiology, sBP < 100 mmHg and CONUT score > 3. In conclusion, NPPV use was associated with a lower incidence of ETI. Particularly, patients with ischemic etiology, high sBP, and better nutritional status might benefit from NPPV use.
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Yukino et al. (2021) conducted a cohort in Acute decompensated heart failure (ADHF) (n=3,927). Non-invasive positive pressure ventilation (NPPV) vs. No non-invasive positive pressure ventilation (non-NPPV) was evaluated on Endotracheal intubation (ETI) during index hospitalization (RR 0.515). Non-invasive positive pressure ventilation was associated with a lower rate of endotracheal intubation (RR 0.515 in propensity-matched analysis) and comparable in-hospital mortality in ADHF.
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