Benefit and harm of intravenous vasodilators across the clinical profile spectrum in acute cardiogenic pulmonary oedema patients.
Acute Disease
Aged
Aged, 80 and over
Blood Pressure
/ drug effects
Female
Follow-Up Studies
Heart Failure
/ complications
Humans
Infusions, Intravenous
Japan
/ epidemiology
Male
Prognosis
Pulmonary Edema
/ drug therapy
Retrospective Studies
Survival Rate
/ trends
Vasodilation
/ drug effects
Vasodilator Agents
/ administration & dosage
Acute heart failure
atrial fibrillation
blood pressure
natriuretic peptide
vasodilator
Journal
European heart journal. Acute cardiovascular care
ISSN: 2048-8734
Titre abrégé: Eur Heart J Acute Cardiovasc Care
Pays: England
ID NLM: 101591369
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
pubmed:
30
1
2020
medline:
12
5
2021
entrez:
30
1
2020
Statut:
ppublish
Résumé
The absence of high quality, large-scale data that indicates definitive mortality benefits does not allow for firm conclusions on the role of intravenous vasodilators in acute heart failure. We aimed to investigate the associations between intravenous vasodilators and clinical outcomes in acute heart failure patients, with a specific focus on patient profiles and type of vasodilators. Data of 26,212 consecutive patients urgently hospitalised for a primary diagnosis of acute heart failure between 2009 and 2015 were extracted from a government-funded multicentre data registration system. Propensity scores were calculated with multiple imputations and 1:1 matching performed between patients with and without vasodilator use. The primary endpoint was inhospital mortality. On direct comparison of the vasodilator and non-vasodilator groups after propensity score matching, there were no significant differences in the inhospital mortality rates (7.5% vs. 8.8%, respectively; In acute heart failure patients, vasodilator use was not universally associated with improved inhospital outcomes; rather, its effect depended on individual clinical presentation: patients with higher systolic blood pressure and no atrial fibrillation seemed to benefit maximally from vasodilators. UMIN-CTR identifier, UMIN000013128.
Sections du résumé
BACKGROUND
BACKGROUND
The absence of high quality, large-scale data that indicates definitive mortality benefits does not allow for firm conclusions on the role of intravenous vasodilators in acute heart failure. We aimed to investigate the associations between intravenous vasodilators and clinical outcomes in acute heart failure patients, with a specific focus on patient profiles and type of vasodilators.
METHODS
METHODS
Data of 26,212 consecutive patients urgently hospitalised for a primary diagnosis of acute heart failure between 2009 and 2015 were extracted from a government-funded multicentre data registration system. Propensity scores were calculated with multiple imputations and 1:1 matching performed between patients with and without vasodilator use. The primary endpoint was inhospital mortality.
RESULTS
RESULTS
On direct comparison of the vasodilator and non-vasodilator groups after propensity score matching, there were no significant differences in the inhospital mortality rates (7.5% vs. 8.8%, respectively;
CONCLUSIONS
CONCLUSIONS
In acute heart failure patients, vasodilator use was not universally associated with improved inhospital outcomes; rather, its effect depended on individual clinical presentation: patients with higher systolic blood pressure and no atrial fibrillation seemed to benefit maximally from vasodilators.
TRIAL REGISTRATION
BACKGROUND
UMIN-CTR identifier, UMIN000013128.
Identifiants
pubmed: 31995391
doi: 10.1177/2048872619891075
doi:
Substances chimiques
Vasodilator Agents
0
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM