Patients admitted with acute heart failure at an intensive care department of a tertiary care hospital: characterization of patients submitted to mechanical circulatory support
Authors: Moura A , Reina-Couto M , Roncon De Albuquerque R , Paiva JA 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Heart failure (HF) is one of the major contemporary challenges. Its prognosis gets worse in the presence of exacerbations that require intensive care. In the last decades there has been a huge advance in techniques of mechanical circulatory support (MCS). Data regarding characterization and prognosis of critical acute heart failure (AHF) in the contemporary era in Portugal is lacking.

Aims
To characterize the patients admitted with AHF and submitted to MCS in an ICU at a Portuguese tertiary care hospital.

Methods
Retrospective study of patients admitted at an ICU with the diagnosis of AHF and submitted to MCS between January and December of 2019 in a tertiary care hospital. Patients were analysed regarding clinical data, triggers and in-hospital and long-term prognosis.

Results
In the reported time frame there were 23 patients admitted for AHF submitted to MCS (9.6% of all AHF patients). They were predominantly men (69.6%), with a mean age of 50.7±16.7 years old. The majority didn’t have a previous HF diagnosis (78.3%). Mean ejection fraction at admission was 25.4±15.8%; the majority presented with low peripheral perfusion (95.7%) and almost a quarter (21.7%) had sudden cardiac arrest at admission. Acute coronary syndrome (ACS) was the most common underlying trigger (34.8%). Venoarterial extracorporeal membrane oxygenation (VA-ECMO) was the most used type of MCS (73.9%), mainly as bridge to recovery (52.9%), with a mean duration of 12.0±6.7 days. In this subgroup, myocarditis was the most common trigger (35.3%). Complications associated with this technique were observed in 46.2% of the cases with bleeding from puncture sites being the most common (23.1%; n=3). Intra-aortic balloon pump was used in 56.5% of the patients, having ACS has the main trigger; there was the need to upgrade to VA-ECMO in about half of the patients (53.8%). There were associated complications in 15% of the cases. Impella was used in 13% of the patients (n=2) for an average of 5.7±0.6 days and always in simultaneous with VA-ECMO; one patient evolved with hematoma in the puncture site. About half (52.2%; n=12) of the patients died during index hospitalization, with 2 casualties occurring in the first 24h. From those who survived, no one had a new hospitalization due to HF or death within 12 months after discharge.

Conclusions
This registry demonstrates that MCS in AHF is predominantly used in younger patients, with less comorbidities and with ACS and myocarditis having a relevant role as underlying triggers. ECMO-VA is the preferred technique, and it is mostly applied in a strategy of bridge to recovery. In-hospital mortality is significant. However, in the surviving patients, the severity of the presentation at the index admission does not translate in long term outcome, with no death casualties or new re-hospitalization for AHF reported. These findings support and give arguments to the use of this aggressive measures.