Bronchodilator therapy in acute decompensated heart failure patients without a history of chronic obstructive pulmonary disease.
Publication/Presentation Date
1-1-2008
Abstract
STUDY OBJECTIVE: Inhaled bronchodilators are often used in the emergency department (ED) before a definitive diagnosis is made. We evaluated the association between inhaled bronchodilators and outcomes in acute decompensated heart failure patients without chronic obstructive pulmonary disease.
METHODS: We conducted an analysis of the Acute Decompensated Heart Failure National Registry Emergency Module registry of patients with a principal discharge diagnosis of acute decompensated heart failure enrolled at 76 academic or community EDs. Dichotomous outcomes (mortality, ED discharges, ICU admission, ED i.v. vasodilator use, new dialysis, ED or in patient endotracheal intubation, ED BiPAP, and asymptomatic at discharge) in patients without a history of chronic obstructive pulmonary disease who were given bronchodilators were compared to those who were not given bronchodilators using logistic regression; odds ratios (ORs) and 95% confidence intervals (CIs) were calculated; and propensity score adjustments were made.
RESULTS: Of the 10,978 patients enrolled, 7299 (66.5%) did not have a history of chronic obstructive pulmonary disease. Bronchodilators were administered by the EMS or in the ED to 2317 (21%) patients. Patients without chronic obstructive pulmonary disease given bronchodilators were more likely to receive ED i.v. vasodilators (28.4% vs. 16.9%; propensity adjusted OR 1.40 [95% CI 1.18-1.67]) and in-patient mechanical ventilation (6.0% vs. 2.4%; propensity adjusted OR 1.69 [95% CI 1.21-2.37]) than patients without chronic obstructive pulmonary disease who were not given bronchodilators. Hospital mortality in patients without chronic obstructive pulmonary disease was similar regardless of bronchodilator treatment (3.4% vs. 2.6%, propensity adjusted OR 1.02 [95% CI 0.67, 1.56]).
CONCLUSION: Many acute decompensated heart failure patients without a history of chronic obstructive pulmonary disease receive inhaled bronchodilators. Bronchodilator use was associated with a greater need for aggressive interventions and monitoring, and this may reflect an adverse effect of bronchodilators or it may be a marker for patients with more severe disease.
Volume
51
Issue
1
First Page
25
Last Page
34
ISSN
1097-6760
Published In/Presented At
Singer, A. J., Emerman, C., Char, D. M., Heywood, J. T., Kirk, J. D., Hollander, J. E., Summers, R., Lee, C. C., Wynne, J., Kellerman, L., & Peacock, W. F. (2008). Bronchodilator therapy in acute decompensated heart failure patients without a history of chronic obstructive pulmonary disease. Annals of emergency medicine, 51(1), 25–34. https://doi.org/10.1016/j.annemergmed.2007.04.005
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
17949853
Department(s)
Administration and Leadership
Document Type
Article