Prospective evaluation of pulmonary edema

Objectives: To describe the clinical profile and hospital outcome of succes sive unselected patients with pulmonary edema hospitalized in an internal m edicine department. Design: Prospective, consecutive, unsolicited patients diagnosed with pulmo nary edema. Setting: An internal medicine department in a 900 tertiary care center. Patients: A total of 150 consecutive unselected patients (90 males, 60 fema les; median age, 75 yrs), Results: Ischemic heart disease, hypertension, various valvular lesions and diabetes mellitus were present in 85%, 70%, 53%, and 52% of patients, resp ectively. Acute myocardial infarction at admission was observed in 15% of p atients. The most common precipitating factors associated with the developm ent of pulmonary edema included: high blood pressure (29%), rapid atrial fi brillation (29%) unstable angina pectoris (25%), infection (18%), and acute myocardial infarction (15%), Twenty-two patients (15%) were mechanically v entilated, Eighteen patients (12%) died while in the hospital, and the caus e of death was cardiac pump failure in 82%, The median hospital stay was 10 days. Predictors for increase rate of in-hospital mortality included: diab etes (p < .05), orthopnea (p < .05), echocardiographic finding of moderate to-severely depressed global left ventricular systolic function (p < .001), acute myocardial infarction during hospital stay (p < .001), hypotension/s hock (p < .05), and the need for mechanically ventilation (p < .001), Conclusions: Most patients with pulmonary edema in the internal medicine de partment are elderly, having ischemic heart disease, hypertension, diabetes , and a previous history of pulmonary edema. The overall mortality is high (in-hospital, 12%) and the predictors associated with high in-hospital mort ality are related to left ventricular myocardial function. The long median hospital stay (10 days) and the need for many cardiovascular drugs, impose a considerable cost in the management and health care of these patients.