Impact of Left Ventricular Heart Failure With Preserved Ejection Fraction and Right Ventricular Systolic Heart Failure on Outcomes in the Intensive Care Unit

Abstract

Heart failure is a common diagnosis in the intensive care unit (ICU) with many studies regarding left ventricular systolic dysfunction and ICU outcomes. Less commonly explored are heart failure with preserved ejection fraction (HFpEF), also known as diastolic heart failure, and right ventricular heart failure in ICU outcomes. We sought to study the impact of both diastolic heart failure and right ventricular heart failure on general ICU outcomes. This retrospective cohort study includes 919 patients admitted to an ICU of a major tertiary care medical center with HFpEF, and 298 patients from the same medical center with right ventricular heart failure, comparing outcomes to 6955 control patients without left ventricular systolic or right ventricular heart failure in this general intensive care setting. Primary endpoint was 28-day mortality, with secondary endpoints of 1-year mortality, hospital and intensive care length of stay, length of use of vasopressors, and days on mechanical ventilation. Multivariable regression demonstrated a significant association between HFpEF and improved mortality as compared to controls, but this association is lost at 1-year follow-up. Right ventricular heart failure does not demonstrate any association with 28-day mortality, which was corroborated on sensitivity analysis excluding cardiac or cardiac surgery intensive care patients.