The Prognostic Value of Non–invasive Ventilation in Patients With Acute Heart Failure

Objectives Patients with acute heart failure (AHF) often receive initial non–invasive ventilation (NIV). This study aimed to evaluate the prognostic role of NIV in patients hospitalized for AHF. Methods This was a retrospective cohort study. We enrolled patients admitted to our cardiac intensive care unit with a diagnosis of AHF. Anthropometric, clinical, pharmacological, and instrumental assessments were collected. Both in–hospital and 180–day post–discharge mortality were evaluated. Results Among 200 patients (mean age 81 ± 9 years; 52% male), NIV was applied in 80 cases (40%). These patients had more severe NYHA functional class, a higher prevalence of de novo AHF, required higher diuretic doses, and had longer hospital stays. In multivariate analysis, NIV remained significantly associated with length of stay (LOS) (r = 0.26; p = 0.0004). In–hospital mortality was 5% overall and significantly higher in the NIV group compared to non–NIV patients (10% vs. 1.6%, p < 0.001). At 180 days, mortality was also significantly higher in the NIV group [hazard ratio (HR) 1.84; 95% confidence interval (CI): 1.18–2.85; p = 0.006]. After adjusting for age, BNP, CRP, arterial blood gas parameters, renal function, and LVEF, NIV remained an independent predictor of 180–day mortality (HR 1.61; 95% CI: 1.01–2.54; p = 0.04). Conclusions Patients with AHF who required NIV exhibited more severe disease and longer hospital stays. NIV use was independently associated with both in–hospital and post–discharge mortality, suggesting its potential role as a prognostic marker in AHF.