Annals of Emergency Medicine
Volume 51, Issue 1 , Pages 25-34, January 2008

Bronchodilator Therapy in Acute Decompensated Heart Failure Patients Without a History of Chronic Obstructive Pulmonary Disease

  • Adam J. Singer, MD

      Affiliations

    • Stony Brook University and Medical Center, Stony Brook, NY
    • Corresponding Author InformationAddress for correspondence: Adam J. Singer, MD, Department of Emergency Medicine, Stony Brook University and Medical Center, HSC L4-080, Stony Brook, NY 11794-8350; 631-444-7857, fax 631-444-9719
    • ,
  • Charles Emerman, MD

      Affiliations

    • Cleveland Clinic, Cleveland, OH
    • ,
  • Douglas M. Char, MD

      Affiliations

    • Washington University School of Medicine, St. Louis, MO
    • ,
  • J. Thomas Heywood, MD

      Affiliations

    • Scripps Clinic, La Jolla, CA
    • ,
  • J. Douglas Kirk, MD

      Affiliations

    • University of California, Davis Medical Center, Sacramento, CA
    • ,
  • Judd E. Hollander, MD

      Affiliations

    • University of Pennsylvania Health System, Philadelphia, PA
    • ,
  • Richard Summers, MD

      Affiliations

    • University of Mississippi Medical Center, Jackson, MS
    • ,
  • Christopher C. Lee, MD

      Affiliations

    • Stony Brook University and Medical Center, Stony Brook, NY
    • ,
  • Janet Wynne, MS

      Affiliations

    • Scios Inc., Fremont, CA.
    • ,
  • Lois Kellerman, MA

      Affiliations

    • Scios Inc., Fremont, CA.
    • ,
  • William Frank Peacock, MD

      Affiliations

    • Cleveland Clinic, Cleveland, OH

Received 21 July 2006; received in revised form 25 January 2007 and 22 March 2007; accepted 5 April 2007. published online 19 October 2007.

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.

 
  • ⁎ Variables included in propensity model.

 Supervising editors: Rita K. Cydulka, MD, MS; Michael L. Callaham, MD

 Author contributions: AJS and WFP conceived the study. The registry was designed by all authors. Funding was obtained by all authors from Scioc Inc. Recruitment of participating centers and patients was performed by AJS, CE, DMC, JTH, JDK, JEH, RS, CCL, and WFP. JW and LK provided statistical advice and analyzed the data. AJS supervised the data oversight. AJS drafted the article, and all authors contributed substantially to its revision. AJS takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Both the ADHERE-EM registry and this analysis were funded by Scios Inc. Role of the Sponsor: Scios Inc., in consultation with the Scientific Advisory Committee, was responsible for the design and conduct of the ADHERE-EM registry, as well as the management of the data. Employees of Scios Inc. (Janet Wynne, MS; Lois Kellerman, MA) are authors of the article.

 Publication dates: Available online October 15, 2007.

 Reprints not available from the authors.

PII: S0196-0644(07)00450-7

doi:10.1016/j.annemergmed.2007.04.005

Refers to article:

  • All That Wheezes Is Not Obstructive Pulmonary Disease , 28 August 2007

    Rita K. Cydulka
    Annals of Emergency Medicine January 2008 (Vol. 51, Issue 1, Pages 35-36)

Annals of Emergency Medicine
Volume 51, Issue 1 , Pages 25-34, January 2008