4362Effect of intravenous carperitide versus nitrates as first-line vasodilators on in-hospital outcomes in hospitalized patients with acute heart failure: insight from a nationwide claim-based database

Background: Carperitide (CAR) is a recombinantly produced intravenous formulation of human atrial natriuretic peptide. Despite of negative impacts of nesiritide on clinical outcomes for acute heart failure (AHF), CAR has been used for around a half of Japanese AHF patients as a vasodilator based on limited evidences. Purpose: This study sought to determine the effect of CAR compared to nitrates in the early care for AHF patients treated with vasodilators. Methods and results: We conducted a cohort study of patients admitted with AHF to 808 hospitals from April 2012 to March 2014. Patients were extracted from 1,422,703 hospitalizations according to ICD-10 HF codes. Patients who had sepsis or mechanical supports during hospitalization were excluded. Outcomes were in-hospital death, length of hospitalization and cost of hospitalization. Among 78,114 patients, 39,427 were in patients treated with either CAR or nitrates during the first 2 days (CAR; 28,129, nitrates; 11,298). After application of inverse probability of treatment weighting with variables including demographics, comorbidities and treatments, there was perfect balance in both groups. Patients who were treated with CAR had substantially higher covariate adjusted in-hospital mortality, longer length of hospitalization and greater cost of hospitalization compared to those treated with nitrates (Table1).