Alexandre Mebazaa1,2,3, Justina Motiejunaite1,2,4, Etienne Gayat1,2,3, Maria G Crespo-Leiro5, Lars H Lund6, Aldo P Maggioni7, Ovidiu Chioncel8, Eiichi Akiyama1,9, Veli-Pekka Harjola10, Petar Seferovic11, Cecile Laroche12, Marisa Sanz Julve13, Eulalia Roig14, Frank Ruschitzka15, Gerasimos Filippatos16. 1. INSERM U942, BIOmarkers in CArdioNeuroVAScular diseases, Paris, France. 2. APHP, Department of Anesthesiology and Critical Care, Saint Louis Lariboisière Hospitals, Paris, France. 3. Université Paris Diderot, Paris, France. 4. Department of Cardiology, Lithuanian University of Health Sciences Hospital Kaunas Clinics, Kaunas, Lithuania. 5. Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco-CIBERCV and Instituto Investigación Biomedica A Coruna (INIBIC), Complexo Hospitalario Universitario A Coruna (CHUAC), La Coruna, Spain. 6. Department of Medicine, Karolinska Institutet Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden. 7. ANMCO Research Center, Florence, Italy. 8. Institutul De Urgente Boli Cardiovasculare CC Iliescu, Universitatea de Medicina Carol Davila, Bucharest, Romania. 9. Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan. 10. University of Helsinki, Emergency Medicine, Department of Emergency Care and Services, Helsinki University Hospital, Helsinki, Finland. 11. Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia. 12. EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France. 13. Cardiology Department, Hospital Miguel Servet, Zaragoza, Spain. 14. Department of Cardiology, Heart Failure and Transplantation Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 15. Department of Cardiology, Heart Failure Clinic and Transplantation, University Heart Centre Zurich, Zurich, Switzerland. 16. Athens University Hospital Attikon, Athens, Greece.
Abstract
AIMS: The aim of this study was to assess long-term safety of intravenous cardiovascular agents-vasodilators, inotropes and/or vasopressors-in acute heart failure (AHF). METHODS AND RESULTS: The European Society of Cardiology Heart Failure Long-Term (ESC-HF-LT) registry was a prospective, observational registry conducted in 21 countries. Patients with unscheduled hospitalizations for AHF (n = 6926) were included: 1304 (18.8%) patients received a combination of intravenous (i.v.) vasodilators and diuretics, 833 (12%) patients received i.v. inotropes and/or vasopressors. Primary endpoint was long-term all-cause mortality. Main secondary endpoints were in-hospital and post-discharge mortality. Adjusted hazard ratio (HR) showed no association between the use of i.v. vasodilator and diuretic and long-term mortality [HR 0.784, 95% confidence interval (CI) 0.596-1.032] nor in-hospital mortality (HR 1.049, 95% CI 0.592-1.857) in the matched cohort (n = 976 paired patients). By contrast, adjusted HR demonstrated a detrimental association between the use of i.v. inotrope and/or vasopressor and long-term all-cause mortality (HR 1.434, 95% CI 1.128-1.823), as well as in-hospital mortality (HR 1.873, 95% CI 1.151-3.048) in the matched cohort (n = 606 paired patients). No association was found between the use of i.v. inotropes and/or vasopressors and long-term mortality in patients discharged alive (HR 1.078, 95% CI 0.769-1.512). A detrimental association with inotropes and/or vasopressors was seen in all geographic regions and, among catecholamines, dopamine was associated with the highest risk of death (HR 1.628, 95% CI 1.031-2.572 vs. no inotropes). CONCLUSIONS: Vasodilators did not demonstrate any association with long-term clinical outcomes, while inotropes and/or vasopressors were associated with increased risk of all-cause death, mostly related to excess of in-hospital mortality in AHF.
AIMS: The aim of this study was to assess long-term safety of intravenous cardiovascular agents-vasodilators, inotropes and/or vasopressors-in acute heart failure (AHF). METHODS AND RESULTS: The European Society of Cardiology Heart Failure Long-Term (ESC-HF-LT) registry was a prospective, observational registry conducted in 21 countries. Patients with unscheduled hospitalizations for AHF (n = 6926) were included: 1304 (18.8%) patients received a combination of intravenous (i.v.) vasodilators and diuretics, 833 (12%) patients received i.v. inotropes and/or vasopressors. Primary endpoint was long-term all-cause mortality. Main secondary endpoints were in-hospital and post-discharge mortality. Adjusted hazard ratio (HR) showed no association between the use of i.v. vasodilator and diuretic and long-term mortality [HR 0.784, 95% confidence interval (CI) 0.596-1.032] nor in-hospital mortality (HR 1.049, 95% CI 0.592-1.857) in the matched cohort (n = 976 paired patients). By contrast, adjusted HR demonstrated a detrimental association between the use of i.v. inotrope and/or vasopressor and long-term all-cause mortality (HR 1.434, 95% CI 1.128-1.823), as well as in-hospital mortality (HR 1.873, 95% CI 1.151-3.048) in the matched cohort (n = 606 paired patients). No association was found between the use of i.v. inotropes and/or vasopressors and long-term mortality in patients discharged alive (HR 1.078, 95% CI 0.769-1.512). A detrimental association with inotropes and/or vasopressors was seen in all geographic regions and, among catecholamines, dopamine was associated with the highest risk of death (HR 1.628, 95% CI 1.031-2.572 vs. no inotropes). CONCLUSIONS: Vasodilators did not demonstrate any association with long-term clinical outcomes, while inotropes and/or vasopressors were associated with increased risk of all-cause death, mostly related to excess of in-hospital mortality in AHF.
Authors: Valentine Léopold; Etienne Gayat; Romain Pirracchio; Jindrich Spinar; Jiri Parenica; Tuukka Tarvasmäki; Johan Lassus; Veli-Pekka Harjola; Sébastien Champion; Faiez Zannad; Serafina Valente; Philip Urban; Horng-Ruey Chua; Rinaldo Bellomo; Batric Popovic; Dagmar M Ouweneel; José P S Henriques; Gregor Simonis; Bruno Lévy; Antoine Kimmoun; Philippe Gaudard; Mir Babar Basir; Andrej Markota; Christoph Adler; Hannes Reuter; Alexandre Mebazaa; Tahar Chouihed Journal: Intensive Care Med Date: 2018-06-01 Impact factor: 17.440
Authors: Ovidiu Chioncel; Sean P Collins; Andrew P Ambrosy; Peter S Pang; Razvan I Radu; Elena-Laura Antohi; Josep Masip; Javed Butler; Vlad Anton Iliescu Journal: Am J Ther Date: 2019 Mar/Apr Impact factor: 2.688
Authors: Mohammed Elzeneini; Juan M Aranda; Mohammad Al-Ani; Mustafa M Ahmed; Alex M Parker; Juan R Vilaro Journal: Heart Fail Rev Date: 2020-09-30 Impact factor: 4.214