Continuous Positive Airway Pressure (CPAP) May Not Reduce Short-Term Mortality in Cardiogenic Pulmonary Edema: A Propensity-Based Analysis

Introduction: Continuous positive airway pressure (CPAP) improves patients' condition in case of cardiogenic pulmonary edema (CPE). However, the impact of CPAP on short-term mortality remains a matter of debate. We aimed at estimating the effect of CPAP on short-term mortality in patients treated for a CPE. Methods and Results: We pooled the data from the Acute Heart Failure Global Registry of Standard Treatment and the Etude Francaise l'Innsuficiens Cardiaque Aigue observational cohorts to compare the estimations of the effect on short-term mortality of CPAP, before and after propensity score (PS) matching. A total of 2286 patients with a cardiogenic pulmonary edema were included in the analysis, of whom 321 (14%) received CPAP. Of these, 314 could be matched to a control patient (matched population: n = 628) and were included in the PS analysis. In naive analysis, CPAP application influenced neither short-term mortality (HR: 1.03, 95% CI: 0.73-1.46; P = .86) nor the need for tracheal intubation (OR: 1.04, 95% CI: 0.78-1.40; P = .78). After PS matching, CPAP was associated with a reduction in the need for tracheal intubation (OR: 0.56, 95% CI: 0.37-0.84; P = .005) but it did not reduce short-term mortality (HR: 0.77, 95% CI: 0.47-1.26; P = .30). Conclusions: Despite a reduction in the need for tracheal intubation, CPAP application may not reduce short-term mortality in patients suffering from cardiogenic pulmonary edema. (J Cardiac Fail 2013;19:108-116)