title: Acute decompensated heart failure is routinely treated as a cardiopulmonary syndrome.
abstract: BACKGROUND
  Heart failure as recognized and treated in typical practice may represent a complex condition that defies discrete categorizations. To illuminate this complexity, we examined treatment strategies for patients hospitalized and treated for decompensated heart failure. We focused on the receipt of medications appropriate for other acute conditions associated with shortness of breath including acute asthma, pneumonia, and exacerbated chronic obstructive pulmonary disease.
  
  
  RESULTS
  Using Premier Perspective(®), we studied adults hospitalized with a principal discharge diagnosis of heart failure and evidence of acute heart failure treatment from 2009-2010 at 370 US hospitals. We determined treatment with acute respiratory therapies during the initial 2 days of hospitalization and daily during hospital days 3-5. We also calculated adjusted odds of in-hospital death, admission to the intensive care unit, and late intubation (intubation after hospital day 2). Among 164,494 heart failure hospitalizations, 53% received acute respiratory therapies during the first 2 hospital days: 37% received short-acting inhaled bronchodilators, 33% received antibiotics, and 10% received high-dose corticosteroids. Of these 87,319 hospitalizations, over 60% continued receiving respiratory therapies after hospital day 2. Respiratory treatment was more frequent among the 60,690 hospitalizations with chronic lung disease. Treatment with acute respiratory therapy during the first 2 hospital days was associated with higher adjusted odds of all adverse outcomes.
  
  
  CONCLUSIONS
  Acute respiratory therapy is administered to more than half of patients hospitalized with and treated for decompensated heart failure. Heart failure is therefore regularly treated as a broader cardiopulmonary syndrome rather than as a singular cardiac condition.
authors.affiliation: Division of Cardiology, Columbia University Medical Center, New York, New York, United States of America ; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, United States of America.
authors.forename: Kumar
authors.initials: K
authors.lastname: Dharmarajan
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Strait
authors.forename: Tara
authors.initials: T
authors.lastname: Lagu
authors.forename: Peter K
authors.initials: PK
authors.lastname: Lindenauer
authors.forename: Mary E
authors.initials: ME
authors.lastname: Tinetti
authors.forename: Joanne
authors.initials: J
authors.lastname: Lynn
authors.forename: Shu-Xia
authors.initials: SX
authors.lastname: Li
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008171:Lung Diseases / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult