Bronchodilator therapy in acute decompensated heart failure patients without a history of chronic obstructive pulmonary disease.

Bronchodilator therapy in acute decompensated heart failure patients without a history of chronic obstructive pulmonary disease. Research Abstract Details 

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Bronchodilator therapy in acute decompensated heart failure patients without a history of chronic obstructive pulmonary disease. Abstract Text:

Adam J Singer,Charles Emerman,Douglas M Char,J Thomas Heywood,J Douglas Kirk,Judd E Hollander,Richard Summers,Christopher C Lee,Janet Wynne,Lois Kellerman,William Frank Peacock,Adam J Singer,Charles Emerman,Douglas M Char,J Thomas Heywood,J Douglas Kirk,Judd E Hollander,Richard Summers,Christopher C Lee,Janet Wynne,Lois Kellerman,William Frank Peacock,Adam J Singer,Charles Emerman,Douglas M Char,J Thomas Heywood,J Douglas Kirk,Judd E Hollander,Richard Summers,Christopher C Lee,Janet Wynne,Lois Kellerman,William Frank Peacock,

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 IV 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 IV 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.

Bronchodilator therapy in acute decompensated heart failure patients without a history of chronic obstructive pulmonary disease. Publishing Authors By Initials

AJ Singer,C Emerman,DM Char,JT Heywood,JD Kirk,JE Hollander,R Summers,CC Lee,J Wynne,L Kellerman,WF Peacock,AJ Singer,C Emerman,DM Char,JT Heywood,JD Kirk,JE Hollander,R Summers,CC Lee,J Wynne,L Kellerman,WF Peacock,AJ Singer,C Emerman,DM Char,JT Heywood,JD Kirk,JE Hollander,R Summers,CC Lee,J Wynne,L Kellerman,WF Peacock,

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Bronchodilator therapy in acute decompensated heart failure patients without a history of chronic obstructive pulmonary disease. Journal Published:

PUBLICATION TYPE: Journal Article

Journal: Annals of emergency medicine

VOLUME: 51

Page Numbers: 25-34

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ISSN: 1097-6760

DAY: 18

MONTH: 10

YEAR: 2007

Bronchodilator therapy in acute decompensated heart failure patients without a history of chronic obstructive pulmonary disease. Information

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LANGUAGE: eng

NlmUniqueID: 8002646

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AFFILIATION: Stony Brook University and Medical Center, Stony Brook, NY.

Country: United States

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MEDLINETA: Ann Emerg Med

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