Use of noninvasive versus invasive ventilation in patients hospitalized with acute exacerbation of heart failure: a Nationwide Readmissions Database study

Q: What are the key findings of this study?

Invasive mechanical ventilation was associated with lower odds of 30-day all-cause readmission (OR 0.75) compared with noninvasive ventilation in patients with acute decompensated heart failure.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute decompensated heart failure (ADHF) (n=74431). Intervention: Invasive mechanical ventilation vs. Noninvasive ventilation. Primary outcome: 30-day all-cause readmission (OR 0.75, 95% CI 0.69-0.82, p=<0.001).

Q: What does this research mean for the field?

Invasive mechanical ventilation in acute decompensated heart failure is associated with lower 30-day all-cause readmission compared with noninvasive ventilation, despite higher in-hospital mortality and costs. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the association between ventilation modality (noninvasive ventilation versus invasive mechanical ventilation) and 30-day all-cause readmission and in-hospital outcomes in adults hospitalized with acute decompensated heart failure.

Adarsh Raja; Muhammad Saad; Fozan Memon; Shayan Asad Khan; Muhammad Hashir; Emaan Mahmood; Areen Zia; Muhammed Umer; Abdullah Humayun; Muhammad Hussain Mansoor; Aamna Kamdi; Haiya Mahmood; Neelam Kumari; Hassan Raza Khan; Laksh Kumar; Sumet Kumar; Fnu Sorath; Subhash Chander; Aayush Chaulagain

doi:10.1097/ms9.0000000000005478

Key result

IMV linked to ~25% lower 30-day readmissions vs. NIV in acute decompensated heart failure.

OR 0.75
95% CI 0.69-0.82
P<0.001
n=74,431

Why the study?

Respiratory compromise requiring ventilatory support is common in ADHF, and NIV may improve outcomes and reduce mortality compared with IMV, but the association between ventilation modality and 30-day all-cause readmission required evaluation.

Does invasive mechanical ventilation reduce 30-day all-cause readmission compared to noninvasive ventilation in adults hospitalized with acute decompensated heart failure?

Key Points

To evaluate the association between ventilation modality (noninvasive ventilation versus invasive mechanical ventilation) and 30-day all-cause readmission and in-hospital outcomes in adults hospitalized with acute decompensated heart failure.
Analyzed 74 431 adult patients aged 18 years or older hospitalized with a principal diagnosis of acute decompensated heart failure requiring ventilatory support from the 2016–2017 Nationwide Readmissions Database.
Categorized patients by initial ventilatory modality into noninvasive ventilation (N = 60 002, 81%) and invasive mechanical ventilation (N = 14 429, 19%), evaluating outcomes using survey-weighted multivariable logistic regression.
Invasive mechanical ventilation was associated with significantly lower 30-day all-cause readmission rates compared to noninvasive ventilation (14 vs. 19%; OR, 0.75; 95% CI, 0.69–0.82; P < 0.001).
In-hospital mortality was fivefold higher among patients managed with invasive mechanical ventilation compared to noninvasive ventilation (33 vs. 6.6%; P < 0.001).
Invasive mechanical ventilation was associated with longer median hospital stays (10 vs. 5 days; P < 0.001), higher median inflation-adjusted charges ($124 832 vs. $43 298; P < 0.001), and more non-home discharges (62 vs. 34%; P < 0.001).

Study Design

Type

Cohort (n=74,431)

Multicenter

Yes

Structured PICO

Does invasive mechanical ventilation reduce 30-day all-cause readmission compared to noninvasive ventilation in adults hospitalized with acute decompensated heart failure?

P

Population

74,431 adults aged 18 years or older hospitalized with acute decompensated heart failure requiring ventilatory support, evaluated for 30-day all-cause readmission.

E

Exposure

Invasive mechanical ventilation (IMV) during index hospitalization

C

Comparator

Noninvasive ventilation (NIV) during index hospitalization

O

Outcome

30-day all-cause readmissionhard clinical

Main Result

Odds Ratio: 0.75 (95% CI 0.69–0.82)

Absolute Event Rate: 14% vs 19%

p-value: p=<0.001

In patients hospitalized with acute decompensated heart failure, invasive mechanical ventilation is associated with higher in-hospital mortality and costs but lower 30-day readmission rates compared to noninvasive ventilation, likely reflecting survivor bias and higher rates of discharge to skilled care facilities.

Limitations

Restricted to a single year of NRD data, limiting assessment of temporal trends.
Observational nature using administrative data precludes causal inferences.
Lacks granular clinical data on post-discharge follow-up, outpatient care, and medication adherence.
Relies on ICD-10-PCS billing codes without time-stamped procedural data, preventing determination of chronological sequence.
Does not capture the duration of ventilatory support.
Residual confounding and indication bias cannot be fully excluded.
Tracks patients only within a single calendar year, limiting longitudinal follow-up.
Captures only in-hospital mortality, potentially underestimating true mortality rates.
Lacks granular clinical data, including information on post-discharge follow-up, outpatient care, and adherence.
Relies on ICD-10-PCS billing codes lacking time-stamped procedural data, preventing determination of chronological sequence of ventilation modalities.
Residual confounding and indication bias cannot be fully excluded as patients requiring IMV represent an inherently more critically ill population.

Implication

Should not yet change ventilation strategy in acute decompensated heart failure; leaves open confounding by survivor bias and illness severity.

Abstract

Background: Respiratory compromise requiring ventilatory support is common in acute decompensated heart failure (ADHF). Noninvasive ventilation (NIV) may improve outcomes and reduce mortality compared with invasive mechanical ventilation (IMV). This study evaluated the association between ventilation modality and 30-day all-cause readmission. Methods: Using data from the 2016–2017 Nationwide Readmissions Database, adults aged 18 years or older who were hospitalized with a principal diagnosis of ADHF and received ventilatory support were identified. The primary outcome was 30-day all-cause readmission. Secondary outcomes included in-hospital mortality, length of stay, hospitalization charges, and discharge disposition. Results: Among 74 431 included patients, IMV use was linked to significantly worse in-hospital outcomes. In-hospital mortality was higher with IMV (33 vs. 6.6%; P < 0.001). Median length of stay was longer (10 vs. 5 days; P < 0.001), and hospitalization charges were greater ($124 832 vs. $43 298; P < 0.001). Non-home discharges were more frequent in the IMV group (62 vs. 34%; P < 0.001). Despite these adverse findings, IMV patients had lower 30-day all-cause readmission rates compared with NIV (14 vs. 19%; P < 0.001). Conclusion: IMV in ADHF is associated with higher mortality, longer hospitalizations, and increased costs but lower 30-day readmissions. Hospitals caring for these sicker patients, often teaching institutions, may face disproportionate financial penalties. Risk adjustment of Hospital Readmission Reduction Program metrics for ventilation modality and discharge disposition should be considered.

Discussion

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Cite This Study

Raja et al. (2026) conducted a cohort in Acute decompensated heart failure (ADHF) (n=74,431). Invasive mechanical ventilation vs. Noninvasive ventilation was evaluated on 30-day all-cause readmission (OR 0.75, 95% CI 0.69-0.82, p=<0.001). Invasive mechanical ventilation was associated with lower odds of 30-day all-cause readmission (OR 0.75) compared with noninvasive ventilation in patients with acute decompensated heart failure.

synapsesocial.com/papers/6aab56cde8ab0d728b914c27 https://doi.org/10.1097/ms9.0000000000005478

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Use of noninvasive versus invasive ventilation in patients hospitalized with acute exacerbation of heart failure: a Nationwide Readmissions Database study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Use of noninvasive versus invasive ventilation in patients hospitalized with acute exacerbation of heart failure: a Nationwide Readmissions Database study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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