Abstract 4361550: A Dangerous Right Turn: Primary Right Heart Failure in Mechanically Ventilated Patients—-Prevalence, Inpatient Outcomes, and High Use of Advanced ICU Therapies— A Nationwide Analysis

Introduction: Invasive mechanical ventilation (IMV) is often required in critically ill patients. Primary right heart failure (RHF) is increasingly recognized in this population. Small, single-center studies suggest that RHF is associated with worse outcomes. In contrast, left heart failure outcomes have been well studied in this population. Data on the prevalence and outcomes of primary right heart failure (RHF) in ventilated patients remain limited. Using the 2022 Nationwide Readmissions Database (NRD), we evaluated the prevalence and inpatient outcomes of mechanically ventilated patients with primary RHF. Methods: We conducted a retrospective cohort study using the 2022 NRD. Adult hospitalized patients requiring invasive mechanical ventilation (IMV) were identified via ICD-10 procedure codes and stratified into IMV with vs. without right heart failure (RHF). Outcomes included mortality, tracheostomy, AKI, ECMO, DVT, ventricular arrhythmias, mechanical circulatory support (MCS), cardiogenic shock, cardiac arrest, and liver dysfunction. Descriptive statistics compared baseline features. Survey-weighted logistic regression estimated unadjusted and adjusted odds ratios (aOR), adjusting for demographics, income, insurance, hospital size, and hospital teaching status. Results: Among 578,748 patients requiring IMV hospitalizations (weighted n=1,121,755), 4,311 had primary RHF, the median age was 55.9 years, and 42.9% were female. RHF was more frequent in males (47.6% vs. 42.9%, p < 0.001) and was linked with a higher Charlson comorbidity index. In multivariate logistic regression analysis, RHF in ventilated patients was associated with higher odds of inpatient mortality (aOR 1.90, 95% CI: 1.77–2.04, p<0.001), tracheostomy use-prolonged mechanical ventilation (1.22, p=0.024), AKI (1.76, p<0.001), DVT (2.13, p<0.001), ventricular arrhythmias (1.60, p<0.001), cardiogenic shock (4.64, p<0.001), incidence of cardiac arrest (1.73, p<0.001), VV-ECMO use (8.13, p<0.001), MCS use (4.36, p<0.001), and liver dysfunction and failure (2.09, p<0.001). RHF was not associated with high continuous renal replacement therapy (CRRT) use (aOR 1.04, p=0.512). Conclusion: Our study indicated that primary RHF in IMV patients was associated with higher in-hospital mortality, multiorgan complications, and increased use of advanced ICU therapies. Early recognition and targeted critical care unit management may improve outcomes. Further studies are needed to inform management.