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April 23, 2026Journal of the American College of Cardiology

In-Hospital Mortality in Patients With Acute Decompensated Heart Failure Requiring Intravenous Vasoactive Medications

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Why the study?

Data were limited regarding the effects of the choice of intravenous vasoactive medication on in-hospital mortality in patients hospitalized with ADHF.

Does treatment with intravenous vasodilators (nitroglycerin or nesiritide) compared to positive inotropes (dobutamine or milrinone) reduce in-hospital mortality in patients hospitalized with acute decompensated heart failure?

Population

15,230 patients hospitalized with ADHF receiving intravenous vasoactive medications

Comparison

Nitroglycerin vs nesiritide vs milrinone vs dobutamine

Design

Retrospective analysis of multicenter registry data

Key result

Intravenous nitroglycerin was associated with lower in-hospital mortality compared to milrinone (OR 0.69; 95% CI 0.53-0.89; p<=0.005) in patients with acute decompensated heart failure.

Authors

WAWilliam T. AbrahamKAKirkwood F. AdamsGFGregg C. Fonarow

Discussion

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Overview

Should not yet change practice favoring vasodilators over inotropes in ADHF; leaves open causality due to observational design.

Key Points

  • This research aims to compare the in-hospital mortality rates of patients with acute decompensated heart failure receiving different intravenous vasoactive medications.
  • Retrospective analysis of 65,180 patient episodes from the Acute Decompensated Heart Failure National Registry (ADHERE)
  • Identified and reviewed cases of 15,230 patients treated with nitroglycerin, nesiritide, milrinone, or dobutamine
  • Calculated risk factor and propensity score-adjusted odds ratios (ORs) for in-hospital mortality.
  • Patients receiving nitroglycerin showed an OR of 0.69 (95% CI 0.53 to 0.89, p ≤ 0.005) for lower mortality compared to milrinone.
  • Nesiritide had an OR of 0.59 (95% CI 0.48 to 0.73, p ≤ 0.005) for lower mortality compared to milrinone.
  • Both natriuretic peptides were associated with significantly lower mortality compared to inotropic therapies.

Study Design

Type

Observational (n=15,230)

Multicenter

Yes

Structured PICO

Does treatment with intravenous vasodilators (nitroglycerin or nesiritide) compared to positive inotropes (dobutamine or milrinone) reduce in-hospital mortality in patients hospitalized with acute decompensated heart failure?

P
Population
15,230 patients hospitalized with acute decompensated heart failure (ADHF) receiving intravenous vasoactive medications
I
Intervention
Intravenous vasodilators (nitroglycerin or nesiritide)
C
Comparator
Intravenous positive inotropes (dobutamine or milrinone)
O
Outcome
In-hospital mortalityhard clinical

Main Result

Effect estimate: OR 0.69 (95% CI 0.53-0.89)

p-value: p=<=0.005

In patients with acute decompensated heart failure, the use of intravenous vasodilators (nitroglycerin or nesiritide) is associated with significantly lower in-hospital mortality compared to positive inotropes (dobutamine or milrinone).

Cite This Study

Abraham et al. (2005) conducted an observational in Acute decompensated heart failure (n=15,230). Intravenous nitroglycerin or nesiritide vs. Intravenous milrinone or dobutamine was evaluated on In-hospital mortality (OR 0.69, 95% CI 0.53-0.89, p=<=0.005). Intravenous nitroglycerin was associated with lower in-hospital mortality compared to milrinone (OR 0.69; 95% CI 0.53-0.89; p<=0.005) in patients with acute decompensated heart failure.

synapsesocial.com/papers/69e9e406f7325a04e8c2e036https://doi.org/10.1016/j.jacc.2005.03.051
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