The Influence of Heart Failure and Ventilatory Support Mode on Hospital Morbidity and Mortality in Patients With or at Risk of Obesity Hypoventilation Syndrome: Findings From the National Inpatient Sample.

Abstract

Heart failure (HF) is common in obesity hypoventilation syndrome (OHS). We explored the impact of HF on in-hospital outcomes of patients with or at risk of OHS who were treated with mechanical ventilation (MV), noninvasive ventilation (NIV), or both. What is the outcome of patients with OHS who experience HF? The National Inpatient Sample (2016-2020) was queried to extract data on patients with or at risk of OHS. The association of adverse outcomes with HF in patients with OHS was explored by analysis adjusted for clinically relevant confounders. Among 72,385 patients hospitalized for OHS, 58.8% of patients received an underlying diagnosis of HF and 26.3% of patients were discharged with a primary diagnosis of HF. Patients with OHS and HF were older (mean age, 60 years vs 54 years), frequently White (56.9% vs 43.1%), had a longer length of stay (median, 6 days vs 5 days), and independently were associated with a need for NIV (OR, 1.35), MV (OR, 1.34) and NIV plus MV (OR, 1.67). Patients with HF showed a lower likelihood of discharge to home (OR, 0.83; P < .001], more in-hospital deaths (OR, 1.27), and more frequent adverse cardiovascular outcomes (OR, 1.20). Use of NIV, MV, or both was higher in patients with HF (36% vs 30%; P < .001), but did not result in improvement in any of the noted outcomes. When NIV was used in conjunction with MV, higher inpatient mortality (OR, 14.8 vs 13.1 vs 1.5), more acute kidney injury (OR, 3.9 vs 3.0 vs 1.3), and more major adverse cardiac events (OR, 2.9 vs 2.4 vs 1.1) were reported when compared with use of either MV or NIV alone. Comorbid HF exists in 59% of hospitalized patients with or at risk of OHS. Use of NIV, MV, or both was higher in patients with HF, but did not result in improvement in any outcomes. All outcomes were worse in patients who received both NIV and MV.