Long-term prognosis of acute pulmonary oedema - an ominous outcome

Background: Acute pulmonary oedema (APOE) is a major health problem, leadin g to poor hospital and long-term outcomes. There is a relative paucity of s tudies describing prognosis of consecutive unsolicited patients diagnosed w ith APOE and hospitalized in internal medicine departments. Aims: To descri be the clinical profile and outcome (in hospital and 1-year prognosis) of s uccessive unselected patients with APOE, in a prospective observational stu dy. Methods and results: The study population included 150 consecutive unso licited patients (90 men, 60 women; median age 75 years) with APOE all hosp italized in an internal medicine department, in a 900-bed care centre. Isch aemic heart disease (IHD), hypertension and diabetes were present in 85%, 7 0% and 52% of patients, respectively. The most common precipitating factors for APOE included high blood pressure (29%), rapid atrial fibrillation (29 %), unstable angina pectoris (25%), infection (18%) and acute myocardial in farction (MI; 15%). Eighteen patients (12%) died in hospital, with 82% of t hese deaths attributed to cardiac pump failure. Predictors for an increased in-hospital mortality included: diabetes (P < 0.05), orthopnoea (P < 0.05) , echocardiographic finding of depressed global left ventricular systolic f unction (P < 0.001), acute MI during hospital stay (P < 0.001), hypotension /shock (P < 0.05), and the need for mechanical ventilation (P < 0.001). Aft er a median hospital stay of 10 days, 132 patients were discharged home. Th e 1-year mortality was 40%. Only the presence of pleural effusion was found as a predictor for 1-year mortality. Conclusion: Most patients with APOE i n this study are elderly, and have IHD, hypertension, diabetes and a previo us history of APOE, The overall mortality is high (in-hospital, 12%: 1-year , 40%). Left ventricular dysfunction was associated with high in-hospital m ortality, but not with long-term prognosis. (C) 2000 European Society of Ca rdiology. All rights reserved.