© 2000 European Society of Cardiology
Long-term prognosis of acute pulmonary oedema — an ominous outcome
a Department of Internal Medicine C, Rambam Medical Centre and The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology Haifa, Israel
b Department of Cardiology, Rambam Medical Centre and The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology Haifa, Israel
c Department of Epidemiology, Rambam Medical Centre and The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology Haifa, Israel
* Corresponding author. Department of Cardiology, Rambam Medical Centre, P.O. Box 9602, Haifa 31096, Israel. Tel.: +972-4-854-2342; fax: +972-4-854-3451. E-mail address: aroguin{at}rambam.health.gov.il (A. Roguin).
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Abstract |
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Background: Acute pulmonary oedema (APOE) is a major health problem, leading to poor hospital and long-term outcomes. There is a relative paucity of studies describing prognosis of consecutive unsolicited patients diagnosed with APOE and hospitalized in internal medicine departments.
Aims: To describe the clinical profile and outcome (in hospital and 1-year prognosis) of successive unselected patients with APOE, in a prospective observational study.
Methods and results: The study population included 150 consecutive unsolicited patients (90 men, 60 women; median age 75 years) with APOE all hospitalized in an internal medicine department, in a 900-bed care centre. Ischaemic heart disease (IHD), hypertension and diabetes were present in 85%, 70% and 52% of patients, respectively. The most common precipitating factors for APOE included high blood pressure (29%), rapid atrial fibrillation (29%), unstable angina pectoris (25%), infection (18%) and acute myocardial infarction (MI; 15%). Eighteen patients (12%) died in hospital, with 82% of these deaths attributed to cardiac pump failure. Predictors for an increased in-hospital mortality included: diabetes (P < 0.05), orthopnoea (P < 0.05), echocardiographic finding of depressed global left ventricular systolic function (P < 0.001), acute MI during hospital stay (P < 0.001), hypotension/shock (P < 0.05), and the need for mechanical ventilation (P < 0.001). After a median hospital stay of 10 days, 132 patients were discharged home. The 1-year mortality was 40%. Only the presence of pleural effusion was found as a predictor for 1-year mortality.
Conclusion: Most patients with APOE in this study are elderly, and have IHD, hypertension, diabetes and a previous history of APOE. The overall mortality is high (in-hospital, 12%: 1-year, 40%). Left ventricular dysfunction was associated with high in-hospital mortality, but not with long-term prognosis.
Key Words: Atrial fibrillation • Diabetes • Hypertension • Ischaemic heart disease • Mechanical ventilation • Myocardial infarction • Pulmonary oedema • Shock
Received September 22, 1999; Revised February 29, 2000; Accepted March 6, 2000
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