RESUMO
BACKGROUND: Congestive heart failure (CHF) is a well-recognized risk factor for venous thromboembolism (VTE) and is associated with higher mortality in patients with an acute pulmonary embolism (PE). There are very few data on how acute PE affects the clinical course of patients with heart failure. The purpose of this study was to determine the impact of an acute PE on the short-term prognosis of patients hospitalized for decompensated CHF. METHODS: This was a prospective cohort study of 198 patients admitted to a coronary care unit between July 2001 and March 2003 with severe decompensated CHF. The primary outcome measure was death or rehospitalization at 3 months. RESULTS: PE was confirmed in 18 of 198 patients enrolled (9.1%). The groups with and without PE were comparable with regards to demographics, the prevalence of comorbid conditions, and severity of CHF (p > 0.05). The prevalence of cancer (p = 0.0001), previous VTE (p = 0.003), and right ventricular overload (p = 0.006) was higher in the PE group. The presence of PE was also associated with a longer hospital stay (37.5 +/- 71.6 days vs 15.4 +/- 15.0 days, p = 0.001) [mean +/- SD] and a higher incidence of death or rehospitalization at 3 months (72.2% vs 43.9%, p = 0.02). In a multiple logistic regression analysis, PE remained an independent predictor of death or rehospitalization at 3 months (odds ratio, 4.0; 95% confidence interval, 1.1 to 15.1; p = 0.038). CONCLUSIONS: Acute PE commonly complicates the hospital course of patients with severe CHF, increasing the length of hospital stay and the chance of death or rehospitalization at 3 months.
Assuntos
Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/mortalidade , Embolia Pulmonar/etiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: Describe the clinical characteristics and identify potential risk factors for in-hospital lethality in patients with decompensated heart failure admitted to an intensive care unit. METHODS: Decompensated heart failure patients consecutively admitted to an intensive care unit between June 2001 and December 2003 were selected and followed during hospitalization until discharge or death. Clinical characteristics at admission were recorded and evaluated as independent risk predictors for in-hospital mortality by multiple logistic regression analysis. RESULTS: A total of 299 patients (69+/-13 years of age and 54% men) were enrolled. Coronary artery disease was the main cause of heart failure in 49% of the cases. Diabetes mellitus and systemic arterial hypertension occurred in 37.5% and 78% of the patients, respectively. At admission, 22% of them had atrial fibrillation, 21.5% had renal dysfunction, and 48% anemia (16.5% with severe anemia). Severe systolic dysfunction (left ventricular ejection fraction <30%) affected 44% of the patients. In-hospital mortality was 17.4%. After the multivariate analysis had been performed, previous history of stroke, atrial fibrillation, renal failure, age > 70 years, and hyponatremia were independently associated with in-hospital mortality. CONCLUSION: Patients admitted to an intensive care unit due to decompensated heart failure have high in-hospital lethality. In this study, variables recorded at admission, such as previous stroke, atrial fibrillation, hyponatremia, renal failure, and age > 70 years were predictors of in-hospital lethality.
Assuntos
Insuficiência Cardíaca/mortalidade , Mortalidade Hospitalar , Unidades de Terapia Intensiva/estatística & dados numéricos , Idoso , Brasil/epidemiologia , Complicações do Diabetes , Métodos Epidemiológicos , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Admissão do Paciente/estatística & dados numéricos , Fatores SexuaisRESUMO
OBJETIVO: Descrever as características clínicas e identificar potenciais fatores de risco para letalidade hospitalar em pacientes com insuficiência cardíaca descompensada, admitidos em unidade de terapia intensiva. MÉTODOS: Pacientes consecutivamente admitidos por insuficiência cardíaca descompensada numa unidade de terapia intensiva, de junho/2001 a dezembro/2003, foram selecionados e seguidos durante a internação. Características clínicas na admissão foram coletadas e avaliadas por meio de modelos de regressão logística múltipla como preditores de risco para letalidade hospitalar. RESULTADOS: Foram avaliados 299 pacientes, 54 por cento do sexo masculino, com média de idade de 69±13 anos. Doença arterial coronariana foi a causa principal da falência cardíaca em 49 por cento dos casos. Diabetes mellitus e hipertensão arterial sistêmica ocorreram em 37,5 por cento e 78 por cento dos pacientes, respectivamente. Na admissão, 22 por cento dos pacientes apresentavam fibrilação atrial; 21,5 por cento, disfunção renal e 48 por cento dos casos, anemia (16,5 por cento com anemia importante). Encontrou-se disfunção sistólica grave (fração de ejeção do ventrículo esquerdo <30 por cento) em 44 por cento dos pacientes. A letalidade hospitalar foi 17,4 por cento. Após análise multivariada, história prévia de acidente vascular encefálico (AVE), fibrilação atrial, insuficiência renal, idade >70 anos e hiponatremia foram independentemente associados com letalidade hospitalar. CONCLUSÃO: Pacientes internados por insuficiência cardíaca descompensada em unidade intensiva apresentam letalidade hospitalar elevada. Neste estudo, variáveis da admissão puderam predizer letalidade hospitalar, como AVE prévio, fibrilação atrial, hiponatremia, insuficiência renal e idade >70 anos.
Assuntos
Idoso , Feminino , Humanos , Masculino , Mortalidade Hospitalar , Insuficiência Cardíaca/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , Brasil/epidemiologia , Complicações do Diabetes , Métodos Epidemiológicos , Insuficiência Cardíaca/etiologia , Admissão do Paciente/estatística & dados numéricos , Fatores SexuaisRESUMO
OBJECTIVES: To determine the incidence of clinical pulmonary embolism (PE) in a population with severe congestive heart failure (CHF) admitted to a coronary care unit (CCU), and to identify clinical predictors of PE in this population. DESIGN AND SETTING: Prospective, observational study performed in a CCU of a tertiary care hospital between July 2001 and March 2003. PATIENTS: One hundred ninety-eight patients with severe decompensated CHF. MEASUREMENTS AND RESULTS: Of 198 patients recruited, 18 patients (9.1%) received a diagnosis of PE during their hospitalization. Deep vein thrombosis was demonstrated in 8 of 18 patients (44.4%) with PE. Thromboprophylaxis was used by 12 of 18 patients (66.7%) with PE and 126 of 180 patients (70%) without PE (p = 0.77). Both groups were similar with respect to mean age (68.2 +/- 14.1 years vs 69.6 +/- 13.4 years [+/- SD]), proportion of male patients (61.1% vs 55.1%), markers of CHF severity (New York Heart Association functional class > II, ejection fraction < 30%, Na < 136 mEq/L, ischemic etiology), and comorbid conditions (diabetes mellitus, atrial fibrillation, chronic renal failure, hypertension) [p = not significant]. The presence of PE was significantly associated with cancer (relative risk [RR], 8.4; 95% confidence interval [CI], 3.9 to 18.1), immobilization (RR, 5.4; 95% CI, 2.0 to 14.4), previous venous thromboembolism (VTE) [RR, 4.4; 95% CI, 1.7 to 11.3], COPD (RR, 3.1; 95% CI, 1.03 to 9.2), and right ventricle (RV) abnormality (RR, 3.3; 95% CI, 1.3 to 8.0). In a multiple logistic regression analysis, only cancer (odds ratio [OR], 26.9; 95% CI, 4.9 to 146.8), RV abnormality (OR, 9.7; 95% CI, 2.2 to 42.6), and previous VTE (OR, 9.1; 95% CI, 1.28 to 64.7) remained independently associated with PE. CONCLUSIONS: In patients with severe decompensated CHF admitted to a CCU, the incidence of clinical PE is very high despite adequate prophylaxis. Traditional risk factors seemed to play an important role in determining the risk of PE in this population.