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.
Observational (n=15,230)
Yes
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?
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).
Effect estimate: OR 0.69 (95% CI 0.53-0.89)
p-value: p=<=0.005
OBJECTIVES: We sought to compare the in-hospital mortality of patients with acute decompensated heart failure (ADHF) who were receiving parenteral treatment with one of four intravenous vasoactive medications. BACKGROUND: There are limited data regarding the effects of the choice of intravenous vasoactive medication on in-hospital mortality in patients hospitalized with ADHF. METHODS: This was a retrospective analysis of observational patient data from the Acute Decompensated Heart Failure National Registry (ADHERE), a multicenter registry designed to prospectively collect data on each episode of hospitalization for ADHF and its clinical outcomes. Data from the first 65,180 patient episodes (October 2001 to July 2003) were included in this analysis. Cases in which patients received nitroglycerin, nesiritide, milrinone, or dobutamine were identified and reviewed (n = 15,230). Risk factor and propensity score-adjusted odds ratios (ORs) for in-hospital mortality were calculated. RESULTS: Patients who received intravenous nitroglycerin or nesiritide had lower in-hospital mortality than those treated with dobutamine or milrinone. The risk factor and propensity score-adjusted ORs for nitroglycerin were 0.69 (95% confidence interval CI 0.53 to 0.89, p < or = 0.005) and 0.46 (94% CI 0.37 to 0.57, p < or = 0.005) compared with milrinone and dobutamine, respectively. The corresponding values for nesiritide compared with milrinone and dobutamine were 0.59 (95% CI 0.48 to 0.73, p < or = 0.005) and 0.47 (95% CI 0.39 to 0.56, p < or = 0.005), respectively. The adjusted OR for nesiritide compared with nitroglycerin was 0.94 (95% CI 0.77 to 1.16, p = 0.58). CONCLUSIONS: Therapy with either a natriuretic peptide or vasodilator was associated with significantly lower in-hospital mortality than positive inotropic therapy in patients hospitalized with ADHF. The risk of in-hospital mortality was similar for nesiritide and nitroglycerin.
Abraham et al. (Fri,) conducted a 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.