Heart failure: a previous hospitalization with pulmonary edema hospitalisation with pulmonary oedema increased the risk of dying in-hospital.

Clinical bottom line (level 2b)

  1. A third of patients with heart failure given mechanical ventilation died in-hospital.
  2. Patients were at increased risk if dying in-hospital following heart failure if they had been previously hospitalised with cardiogenic pulmonary oedema.
  3. Patients were less likely to die in-hospital following heart failure if they, had systolic blood pressure <130 mmHg, were using calcium channel blockers, had anterior myocardial infarction within 48 hours of intubation
Fedullo et al: Chest 1991; 99: 1220-1226
Expires October 2001

The study

Retrospective cohort study with objective outcomes, adjusted for confounding factors, validated in an independent set of patients.

Setting: general hospital medical intensive care unit, USA

88 patients (aged mean age 74 years, 55% male) respiratory failure caused by cardiogenic pulmonary oedema, requiring mechanical ventilation- required at least two of the following as well as pulmonary oedema: rales, elevated jugular venous pressure, peripheral oedema, S-3 gallop, dyspnoea with exertion, acute myocardial infarction or acute ischaemic chest pain.

Factors studied:
  • in-hospital mortality
  • previous hospitalisation with cardiac pulmonary oedema
  • systolic blood pressure <130 mmHg
  • use of calcium channel blockers
  • anterior myocardial infarction


    • Mechanical ventilation was provided.

    BMDP multiple logistic regression package used to adjust for confounding factors.

    94% followed for mean 17 days
    Outcomes studied:
  • in-hospital mortality

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    in-hospital mortality mean 17 days 32/88 36.4%
    (26.3% to 46.4%)

    prognostic factor for
    in-hospital mortality     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    previous hospitalisation with cardiac pulmonary oedema 17 days 4/88
    (4.54%)     		0.07
    (0.01 to 0.50)     		24
    (22 to 45)
    systolic blood pressure <130 mmHg 17 days 14/88
    (16.0%)     		51.4
    (8.00 to 88.9)     		-1
    (-2 to -1)
    use of calcium channel blockers 17 days 14/88
    (15.9%)     		9.97
    (1.78 to 55.0)     		-2
    (-11 to -1)
    anterior myocardial infarction 17 days 15/88
    (17.0%)     		6.11
    (1.89 to 26.8)     		-3
    (-9 to -1)

    Citation

    1. Fedullo AJ, Swinburne AJ, Wahl GW, et al: Acute cardiogenic pulmonary edema treated with mechanical ventilation: Factors determining in-hospital mortality. Chest 1991; 99: 1220-1226
    Contributor: Clare Wotton and Musab Hayatli, October 1999
    Reviewer:

    Clinical Question.
    Patient pulmonary edema oedema
    Intervention or Exposure risk factors
    Comparison no risk factors
    Outcome in-hospital mortality