Benefit and harm of intravenous vasodilators across the clinical profile spectrum in acute cardiogenic pulmonary oedema patients

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 i...

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Veröffentlicht in:European heart journal. Acute cardiovascular care 2020-08, Vol.9 (5), p.448-458, Article 2048872619891075
Hauptverfasser: Shiraishi, Yasuyuki, Kohsaka, Shun, Katsuki, Toshiomi, Harada, Kazumasa, Miyazaki, Tetsuro, Miyamoto, Takamichi, Matsushita, Kenichi, Iida, Kiyoshi, Takei, Makoto, Yamamoto, Yoshiya, Shindo, Akito, Kitano, Daisuke, Nagatomo, Yuji, Jimba, Takahiro, Yamamoto, Takeshi, Nagao, Ken, Takayama, Morimasa
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container_end_page 458
container_issue 5
container_start_page 448
container_title European heart journal. Acute cardiovascular care
container_volume 9
creator Shiraishi, Yasuyuki
Kohsaka, Shun
Katsuki, Toshiomi
Harada, Kazumasa
Miyazaki, Tetsuro
Miyamoto, Takamichi
Matsushita, Kenichi
Iida, Kiyoshi
Takei, Makoto
Yamamoto, Yoshiya
Shindo, Akito
Kitano, Daisuke
Nagatomo, Yuji
Jimba, Takahiro
Yamamoto, Takeshi
Nagao, Ken
Takayama, Morimasa
description 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: 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: 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; P=0.098) or length of intensive/cardiovascular care unit stay and hospital stay between the two groups. However, there was a substantial difference in baseline systolic blood pressure by vasodilator type; favourable impacts of vasodilator use on inhospital mortality were observed among patients who had higher systolic blood pressures and those who had no atrial fibrillation on admission. Furthermore, when compared to nitrates, the use of carperitide (natriuretic peptide agent) was significantly associated with worse outcomes, especially in patients with intermediate systolic blood pressures. 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: UMIN-CTR identifier, UMIN000013128
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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: 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: 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; P=0.098) or length of intensive/cardiovascular care unit stay and hospital stay between the two groups. However, there was a substantial difference in baseline systolic blood pressure by vasodilator type; favourable impacts of vasodilator use on inhospital mortality were observed among patients who had higher systolic blood pressures and those who had no atrial fibrillation on admission. Furthermore, when compared to nitrates, the use of carperitide (natriuretic peptide agent) was significantly associated with worse outcomes, especially in patients with intermediate systolic blood pressures. 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. 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Acute cardiovascular care</title><addtitle>EUR HEART J-ACUTE CA</addtitle><addtitle>Eur Heart J Acute Cardiovasc Care</addtitle><description>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: 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: 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; P=0.098) or length of intensive/cardiovascular care unit stay and hospital stay between the two groups. However, there was a substantial difference in baseline systolic blood pressure by vasodilator type; favourable impacts of vasodilator use on inhospital mortality were observed among patients who had higher systolic blood pressures and those who had no atrial fibrillation on admission. Furthermore, when compared to nitrates, the use of carperitide (natriuretic peptide agent) was significantly associated with worse outcomes, especially in patients with intermediate systolic blood pressures. 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. 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Biomedicine</topic><topic>Male</topic><topic>Prognosis</topic><topic>Pulmonary Edema - drug therapy</topic><topic>Pulmonary Edema - etiology</topic><topic>Pulmonary Edema - mortality</topic><topic>Retrospective Studies</topic><topic>Science &amp; Technology</topic><topic>Survival Rate - trends</topic><topic>Vasodilation - drug effects</topic><topic>Vasodilator Agents - administration &amp; dosage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shiraishi, Yasuyuki</creatorcontrib><creatorcontrib>Kohsaka, Shun</creatorcontrib><creatorcontrib>Katsuki, Toshiomi</creatorcontrib><creatorcontrib>Harada, Kazumasa</creatorcontrib><creatorcontrib>Miyazaki, Tetsuro</creatorcontrib><creatorcontrib>Miyamoto, Takamichi</creatorcontrib><creatorcontrib>Matsushita, Kenichi</creatorcontrib><creatorcontrib>Iida, Kiyoshi</creatorcontrib><creatorcontrib>Takei, Makoto</creatorcontrib><creatorcontrib>Yamamoto, Yoshiya</creatorcontrib><creatorcontrib>Shindo, Akito</creatorcontrib><creatorcontrib>Kitano, Daisuke</creatorcontrib><creatorcontrib>Nagatomo, Yuji</creatorcontrib><creatorcontrib>Jimba, Takahiro</creatorcontrib><creatorcontrib>Yamamoto, Takeshi</creatorcontrib><creatorcontrib>Nagao, Ken</creatorcontrib><creatorcontrib>Takayama, Morimasa</creatorcontrib><creatorcontrib>Tokyo CCU Network Sci Comm</creatorcontrib><creatorcontrib>for Tokyo CCU Network Scientific Committee</creatorcontrib><collection>Web of Science - Science Citation Index Expanded - 2020</collection><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal. Acute cardiovascular care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shiraishi, Yasuyuki</au><au>Kohsaka, Shun</au><au>Katsuki, Toshiomi</au><au>Harada, Kazumasa</au><au>Miyazaki, Tetsuro</au><au>Miyamoto, Takamichi</au><au>Matsushita, Kenichi</au><au>Iida, Kiyoshi</au><au>Takei, Makoto</au><au>Yamamoto, Yoshiya</au><au>Shindo, Akito</au><au>Kitano, Daisuke</au><au>Nagatomo, Yuji</au><au>Jimba, Takahiro</au><au>Yamamoto, Takeshi</au><au>Nagao, Ken</au><au>Takayama, Morimasa</au><aucorp>Tokyo CCU Network Sci Comm</aucorp><aucorp>for Tokyo CCU Network Scientific Committee</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Benefit and harm of intravenous vasodilators across the clinical profile spectrum in acute cardiogenic pulmonary oedema patients</atitle><jtitle>European heart journal. Acute cardiovascular care</jtitle><stitle>EUR HEART J-ACUTE CA</stitle><addtitle>Eur Heart J Acute Cardiovasc Care</addtitle><date>2020-08</date><risdate>2020</risdate><volume>9</volume><issue>5</issue><spage>448</spage><epage>458</epage><pages>448-458</pages><artnum>2048872619891075</artnum><issn>2048-8726</issn><eissn>2048-8734</eissn><abstract>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: 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: 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; P=0.098) or length of intensive/cardiovascular care unit stay and hospital stay between the two groups. However, there was a substantial difference in baseline systolic blood pressure by vasodilator type; favourable impacts of vasodilator use on inhospital mortality were observed among patients who had higher systolic blood pressures and those who had no atrial fibrillation on admission. Furthermore, when compared to nitrates, the use of carperitide (natriuretic peptide agent) was significantly associated with worse outcomes, especially in patients with intermediate systolic blood pressures. 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: UMIN-CTR identifier, UMIN000013128</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>31995391</pmid><doi>10.1177/2048872619891075</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-3430-4614</orcidid><orcidid>https://orcid.org/0000-0001-7668-3117</orcidid><oa>free_for_read</oa></addata></record>
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subjects Acute Disease
Aged
Aged, 80 and over
Blood Pressure - drug effects
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Female
Follow-Up Studies
Heart Failure - complications
Heart Failure - drug therapy
Heart Failure - physiopathology
Humans
Infusions, Intravenous
Japan - epidemiology
Life Sciences & Biomedicine
Male
Prognosis
Pulmonary Edema - drug therapy
Pulmonary Edema - etiology
Pulmonary Edema - mortality
Retrospective Studies
Science & Technology
Survival Rate - trends
Vasodilation - drug effects
Vasodilator Agents - administration & dosage
title Benefit and harm of intravenous vasodilators across the clinical profile spectrum in acute cardiogenic pulmonary oedema patients
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