Implications of Intravenous Contrast Use in Patients Admitted with Acute Decompensated Heart Failure

Patients admitted with Acute Decompensated Heart Failure (ADHF) are exposed to intravenous contrast agents for various clinical indications. Given the hemodynamic changes that occur during ADHF, it is not clear that the use of intravenous contrast will have any adverse outcome in this group of patients. Hence this quality improvement project designed to see the outcomes of intravenous contrast use in patients with ADHF. Hypothesis: The use of intravenous contrast agents in patients with acute decompensated heart failure can have worse outcome. Methods: All adult patients (>18 years) admitted with primary diagnosis of acute decompensated heart failure (ADHF) during 2013 was included. Patients on hemodialysis, sepsis, terminal cancer and patients who had surgical procedure during the hospital stay were excluded. The included patients were grouped into patients who received contrast and who did not receive intravenous contrast. Primary endpoint was all cause mortality, length of hospital stay and 30-day readmission to hospital. Data was analyzed using IBM SPSS Version 20 software. Results: Of the 338 patients with diagnosis of ADHF, 228 patients met the inclusion criteria. The included patients were divided into contrast received group (n = 65) and non-contrast group (n = 163). The all cause in-hospital mortality was 7.6% in contrast group and 6.7% (P value 0.801) in non-contrast group. There is no significant difference in overall length of stay (P value 0.626) and 30-day readmission (P value 0.661) between these groups. Within contrast received group, patients received contrast for coronary angiogram had lengthy hospital day (5 days and 3.5 days, P value 0.047) The subgroup analysis on elderly patients (age > 80 years) the length of stay was significantly higher in contrast received group (P value 0.044). Conclusions: The use of intravenous contrast agents in patients with acute decompensated heart failure may increase length of stay in elderly patients.