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Prospective evaluation of pulmonary edema

Edoute, Yeouda MD, PhD; Roguin, Ariel MD; Behar, Doron MD; Reisner, Shimon A. MD

Clinical Investigations
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Objectives: To describe the clinical profile and hospital outcome of successive unselected patients with pulmonary edema hospitalized in an internal medicine department.

Design: Prospective, consecutive, unsolicited patients diagnosed with pulmonary edema.

Setting: An internal medicine department in a 900 tertiary care center.

Patients: A total of 150 consecutive unselected patients (90 males, 60 females; 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, respectively. Acute myocardial infarction at admission was observed in 15% of patients. The most common precipitating factors associated with the development of pulmonary edema included: high blood pressure (29%), rapid atrial fibrillation (29%,) unstable angina pectoris (25%), infection (18%), and acute myocardial infarction (15%). Twenty-two patients (15%) were mechanically ventilated. Eighteen patients (12%) died while in the hospital, and the cause of death was cardiac pump failure in 82%. The median hospital stay was 10 days. Predictors for increase rate of in-hospital mortality included: diabetes (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/shock (p< .05), and the need for mechanical ventilation (p< .001).

Conclusions: Most patients with pulmonary edema in the internal medicine department 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 mortality 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.

From the Departments of Internal Medicine C (Drs. Edoute, Roguin, and Behar) and Cardiology (Drs. Roguin and Reisner), Rambam Medical Center, and The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.

Address requests for reprints to: Ariel Roguin, MD, Department of Cardiology, Rambam Medical Center, P.O.B. 9602, 31096 Haifa, Israel. E-mail: aroguin@rambam.health.gov.il

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