Acute pulmonary edema in patients with decompensated heart failure. Role of underlying cardiopathy on the prognosis

Aims To investigate the impact of acute pulmonary edema (APE) on the prognosis of patients hospitalized with congestive heart failure (CHF) and if the underlying cardiopathy influences the survival of these patients. Method and results All patients admitted to the cardiology department of a tertiary hospital with CHF between 1991 and 2002 were included in the present study. APE was diagnosed in 176 of 1659 patients. 60.2% of them were of ischaemic etiology, 48.6% and 42.9% of hypertensive and valvular origin, respectively. Survival analysis carried out in April 2003 has shown that APE patients have higher mortality rates, with a median survival of 3.1 years as against 4.8 years. This difference was due only to the behaviour of patients with ischaemic CHF as among patients with non-ischaemic CHF, the difference in median survival between patients with and without APE was insignificant. Within the APE group the survival of ischaemic patients was lower than that of non-ischaemic (median survival of 2.3 years vs 4.5 years, respectively). The difference was more pronounced between APE patients with CHF of ischaemic and hypertensive origin (median survival of 5.6 years for the latter). Among patients without APE, there was no significant difference between different etiological groups. Conclusion In this study we found that the survival time of CHF patients is significantly shortened by the concurrence of APE and ischaemic etiology but not by either of these factors without the other.