Efficacy of high-flow nasal cannula in patients with acute heart failure: a systematic review and meta-analysis

Background Acute heart failure (AHF) is often associated with diffuse insufficiency and arterial hypoxemia, requiring respiratory support for rapid and effective correction. We aimed to compare the effects of high-flow nasal cannula(HFNC) with those of conventional oxygen therapy(COT) or non-invasive ventilation(NIV) on the prognosis of patients with AHF. Methods We performed the search using PubMed, Embase, Web of Science, MEDLINE, the Cochrane Library, CNKI, Wanfang, and VIP databases from the inception to August 31, 2023 for relevant studies in English and Chinese. We included controlled studies comparing HFNC with COT or NIV in patients with AHF. Primary outcomes included the intubation rate, respiratory rate (RR), heart rate (HR), and oxygenation status. Results From the 1288 original papers identified, 16 studies met the inclusion criteria, and 1333 patients were included. Compared with COT, HFNC reduced the intubation rate (odds ratio [OR]: 0.29, 95% CI: 0.14–0.58, P = 0.0005), RR (standardized mean difference [SMD]: -0.73 95% CI: -0.99 – -0.47, P < 0.00001) and HR (SMD: -0.88, 95% CI: -1.07 – -0.69, P < 0.00001), and hospital stay (SMD: -0.94, 95% CI: -1.76 – -0.12, P = 0.03), and increase arterial oxygen partial pressure (PaO 2 ), (SMD: 0.88, 95% CI: 0.70–1.06, P < 0.00001) and oxygen saturation (SpO 2 [%], SMD: 0.70, 95% CI: 0.34–1.06, P = 0.0001). Conclusions There were no significant differences in intubation rate, RR, HR, arterial blood gas parameters, and dyspnea scores between the HFNC and NIV groups. Compared with COT, HFNC effectively reduced the intubation rate and provided greater clinical benefits to patients with AHF. However, there was no significant difference in the clinical prognosis of patients with AHF between the HFNC and NIV groups. Trial registration PROSPERO (identifier: CRD42022365611).