Similar to our results, that study also found no interaction between diltiazem use and other possible risk factors such as age, sex, and (3-blocker use. The authors suggested that the poorer outcome in this group may be due to the cardiodepressant effect of the drug. Our finding of a greater mortality in patients with pulmonary edema receiving calcium channel blockers is unexplained, but it might have a similar explanation.
A previous episode of pulmonary edema predicted survival in the multivariate model. By univariate analysis, survivors were more likely to have a history of congestive heart failure, peripheral edema at the time of hospital admission, and outpatient use of diuretics. These findings are similar to the report of Goldberger et al that patients with progressively worsening heart failure had a better outcome than those with other causes of acute pulmonary edema. It may be that patients with nonischemic exacerbations of chronic congestive heart failure can be repeatedly and successfully treated with modern therapies, including mechanical ventilation. They do not suffer permanent loss of functional myocardial mass, and return to their previous cardiac status after the acute illness is resolved.