CONGRESS ABSTRACT

AIMS: An increasing number of patients with acute heart failure (AHF) are initially treated with non-invasive ventilation (NIV). The impact of NIV on their prognosis is still a matter of debate. The aim of this study was to evaluate the exact role of NIV on the prognosis of patients who were hospitalized for AHF. METHODS: this was a retrospective cohort study. We enrolled subjects who were admitted to out cardiac intensive care unit with a diagnosis of AHF. Anthropometric, clinical, pharmacological, and instrumental evaluations were adopted in order to identify the possible variables able to impact on the association among NIV use, in-hospital mortality, and post-discharge mortality at 180-day follow-up. RESULTS: Among 200 patients (81±9 years, male 52%) NIV was adopted in 80 patients (40%). This group showed more features of respiratory failure, higher NYHA functional class, “de novo” AHF condition (as compared to “acute decompensation of HF”), use of higher dose of furosemide, and longer length of hospital stay (LOS). Multivariate analysis demonstrated that NIV remained significantly associated to LOS (r=0.26; P=0.0004). The in-hospital mortality (5%) was higher in NIV group when compared with those without NIV: 10% vs 1.6% (P<0.001). At 180-days the mortality was significantly higher in NIV group [hazard ratio (HR) 1.84, 95% CI: 1.18-2.85; P=0.006]. After adjustment for age, BNP, C-reactive protein, arterial blood gas variables, renal and left ventricular function, the NIV treatment remained significant predictor of death at 180 days (HR 1.61, 95% CI: 1.01-2.54; P=0.04). CONCLUSIONS: patients with AHF who required NIV are characterized by more severity of disease and longer LOS. Additionally, they are at higher risk for in-hospital and post-discharge mortality independently from clinical and laboratory parameters. This finding reflects the worse clinical status of patients that required NIV and introduces a potential marker for prognostic stratification in this clinical setting.