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 |
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| 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 |
| doi_str_mv | 10.1177/2048872619891075 |
| format | Article |
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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</description><identifier>ISSN: 2048-8726</identifier><identifier>EISSN: 2048-8734</identifier><identifier>DOI: 10.1177/2048872619891075</identifier><identifier>PMID: 31995391</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>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</subject><ispartof>European heart journal. Acute cardiovascular care, 2020-08, Vol.9 (5), p.448-458, Article 2048872619891075</ispartof><rights>The European Society of Cardiology 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>6</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000510330200001</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c445t-b721f1fc85e5fc660d9359a8b7a4fbfbf928ba6e395461e7003c26520b557c2e3</citedby><cites>FETCH-LOGICAL-c445t-b721f1fc85e5fc660d9359a8b7a4fbfbf928ba6e395461e7003c26520b557c2e3</cites><orcidid>0000-0002-3430-4614 ; 0000-0001-7668-3117</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/2048872619891075$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/2048872619891075$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>315,782,786,21826,27931,27932,28255,43628,43629</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31995391$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><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><title>Benefit and harm of intravenous vasodilators across the clinical profile spectrum in acute cardiogenic pulmonary oedema patients</title><title>European heart journal. 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.
Trial registration:
UMIN-CTR identifier, UMIN000013128</description><subject>Acute Disease</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Blood Pressure - drug effects</subject><subject>Cardiac & Cardiovascular Systems</subject><subject>Cardiovascular System & Cardiology</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart Failure - complications</subject><subject>Heart Failure - drug therapy</subject><subject>Heart Failure - physiopathology</subject><subject>Humans</subject><subject>Infusions, Intravenous</subject><subject>Japan - epidemiology</subject><subject>Life Sciences & Biomedicine</subject><subject>Male</subject><subject>Prognosis</subject><subject>Pulmonary Edema - drug therapy</subject><subject>Pulmonary Edema - etiology</subject><subject>Pulmonary Edema - mortality</subject><subject>Retrospective Studies</subject><subject>Science & Technology</subject><subject>Survival Rate - trends</subject><subject>Vasodilation - drug effects</subject><subject>Vasodilator Agents - administration & dosage</subject><issn>2048-8726</issn><issn>2048-8734</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AOWDO</sourceid><sourceid>EIF</sourceid><recordid>eNqNkctrFTEUxoNY2tJ235VkKchoHpPXUi_1AQU3uh4ymZM2ZSYZk0zFnX-6ud56F4Jgssgh_L7Dd76D0DUlrylV6g0jvdaKSWq0oUSJZ-h8_9Vpxfvnx5rJM3RVygNpRxHZa36Kzjg1RnBDz9HPdxDBh4ptnPC9zQtOHodYs32EmLaCH21JU5htTblg63IqBdd7wG4OMTg74zUnH2bAZQVX87Y0deO22hCbp5DuoHF43eYlRZt_4AQTLBavtgaItVyiE2_nAldP7wX6-v7my-5jd_v5w6fd29vO9b2o3agY9dQ7LUB4JyWZDBfG6lHZ3o_tGqZHK4Eb0UsKihDumBSMjEIox4BfoJeHvs3vtw1KHZZQHMyzjdDmHBjvtTJSSdNQckB_T5vBD2sOS_M-UDLsox_-jr5JXjx138YFpqPgT9ANeHUAvsOYfHFtdgdHrO1GUMI5Yfs17Wn9__Qu1JZliru0xdqk3UFa7B0MD2nLscX6b-e_ANEGrmQ</recordid><startdate>202008</startdate><enddate>202008</enddate><creator>Shiraishi, Yasuyuki</creator><creator>Kohsaka, Shun</creator><creator>Katsuki, Toshiomi</creator><creator>Harada, Kazumasa</creator><creator>Miyazaki, Tetsuro</creator><creator>Miyamoto, Takamichi</creator><creator>Matsushita, Kenichi</creator><creator>Iida, Kiyoshi</creator><creator>Takei, Makoto</creator><creator>Yamamoto, Yoshiya</creator><creator>Shindo, Akito</creator><creator>Kitano, Daisuke</creator><creator>Nagatomo, Yuji</creator><creator>Jimba, Takahiro</creator><creator>Yamamoto, Takeshi</creator><creator>Nagao, Ken</creator><creator>Takayama, Morimasa</creator><general>SAGE Publications</general><general>Sage</general><scope>AOWDO</scope><scope>BLEPL</scope><scope>DTL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3430-4614</orcidid><orcidid>https://orcid.org/0000-0001-7668-3117</orcidid></search><sort><creationdate>202008</creationdate><title>Benefit and harm of intravenous vasodilators across the clinical profile spectrum in acute cardiogenic pulmonary oedema patients</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c445t-b721f1fc85e5fc660d9359a8b7a4fbfbf928ba6e395461e7003c26520b557c2e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Acute Disease</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Blood Pressure - drug effects</topic><topic>Cardiac & Cardiovascular Systems</topic><topic>Cardiovascular System & Cardiology</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart Failure - complications</topic><topic>Heart Failure - drug therapy</topic><topic>Heart Failure - physiopathology</topic><topic>Humans</topic><topic>Infusions, Intravenous</topic><topic>Japan - epidemiology</topic><topic>Life Sciences & 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 & Technology</topic><topic>Survival Rate - trends</topic><topic>Vasodilation - drug effects</topic><topic>Vasodilator Agents - administration & 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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| ispartof | European heart journal. Acute cardiovascular care, 2020-08, Vol.9 (5), p.448-458, Article 2048872619891075 |
| issn | 2048-8726 2048-8734 |
| language | eng |
| recordid | cdi_sage_journals_10_1177_2048872619891075 |
| source | Access via SAGE; MEDLINE; Oxford University Press Journals All Titles (1996-Current); Web of Science - Science Citation Index Expanded - 2020<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /> |
| 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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