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(Chest. 2005;128:2576-2580.)
© 2005 American College of Chest Physicians

Incidence and Clinical Predictors of Pulmonary Embolism in Severe Heart Failure Patients Admitted to a Coronary Care Unit*

Eduardo S. Darze, MD; Adriana L. Latado, MD; Aloyra G. Guimarães, MD; Rodrigo A. V. Guedes, MD; Alessandra B. Santos, MD; Simone S. de Moura, MD and Luiz Carlos S. Passos, MD, PhD

* From the Cardiology Division (Dr. Darze), Hospital Aliança, Salvador; and Coronary Care Unit (Drs. Latado, Guimarães, Guedes, Santos, de Moura, and Passos), Hospital Português, Salvador, Brazil.

Correspondence to: Eduardo S. Darze, MD, Cardiology Division, Echocardiography Laboratory, Hospital Aliança, Avenida Juracy Magalhães Jr., 2096, Salvador, BA, Brazil, 41920-000; e-mail: esdarze{at}ufba.br

Objectives: To determine the incidence of clinical pulmonary embolism (PE) in a population with severe congestive heart failure (CHF) admitted to a coronary care unit (CCU), and to identify clinical predictors of PE in this population.

Design and setting: Prospective, observational study performed in a CCU of a tertiary care hospital between July 2001 and March 2003.

Patients: One hundred ninety-eight patients with severe decompensated CHF.

Measurements and results: Of 198 patients recruited, 18 patients (9.1%) received a diagnosis of PE during their hospitalization. Deep vein thrombosis was demonstrated in 8 of 18 patients (44.4%) with PE. Thromboprophylaxis was used by 12 of 18 patients (66.7%) with PE and 126 of 180 patients (70%) without PE (p = 0.77). Both groups were similar with respect to mean age (68.2 ± 14.1 years vs 69.6 ± 13.4 years [± SD]), proportion of male patients (61.1% vs 55.1%), markers of CHF severity (New York Heart Association functional class > II, ejection fraction < 30%, Na < 136 mEq/L, ischemic etiology), and comorbid conditions (diabetes mellitus, atrial fibrillation, chronic renal failure, hypertension) [p = not significant]. The presence of PE was significantly associated with cancer (relative risk [RR], 8.4; 95% confidence interval [CI], 3.9 to 18.1), immobilization (RR, 5.4; 95% CI, 2.0 to 14.4), previous venous thromboembolism (VTE) [RR, 4.4; 95% CI, 1.7 to 11.3], COPD (RR, 3.1; 95% CI, 1.03 to 9.2), and right ventricle (RV) abnormality (RR, 3.3; 95% CI, 1.3 to 8.0). In a multiple logistic regression analysis, only cancer (odds ratio [OR], 26.9; 95% CI, 4.9 to 146.8), RV abnormality (OR, 9.7; 95% CI, 2.2 to 42.6), and previous VTE (OR, 9.1; 95% CI, 1.28 to 64.7) remained independently associated with PE.

Conclusions: In patients with severe decompensated CHF admitted to a CCU, the incidence of clinical PE is very high despite adequate prophylaxis. Traditional risk factors seemed to play an important role in determining the risk of PE in this population.

Key Words: congestive heart failure • ICU • pulmonary embolism






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