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Clinical Investigations: CARDIOLOGY |

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; Luiz Carlos S. Passos, MD, PhD
Author and Funding Information

*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@ufba.br



Chest. 2005;128(4):2576-2580. doi:10.1378/chest.128.4.2576
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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.


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