April 23, 2026
In-Hospital Mortality in Patients With Acute Decompensated Heart Failure Requiring Intravenous Vasoactive Medications
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.
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
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).
Main Result
Effect estimate: OR 0.69 (95% CI 0.53-0.89)
p-value: p=<=0.005
Abstract
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.
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Authors
William T. Abraham
Heart Failure & Transplant
K
Kirkwood F. Adams
Heart Failure & Transplant
Gregg C. Fonarow
University of California, Los Angeles
Journals
Journal of the American College of Cardiology
Actions
Institutions
University of California, Los Angeles
University of North Carolina at Chapel Hill
The Ohio State University
References and Citations
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