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In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the Acute Decompensated Heart Failure National Registry (ADHERE).
J Am Coll Cardiol. 2005 Jul 05; 46(1):57-64.JACC

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.

Authors+Show Affiliations

Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA. abraham-1@medctr.osu.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15992636

Citation

Abraham, William T., et al. "In-hospital Mortality in Patients With Acute Decompensated Heart Failure Requiring Intravenous Vasoactive Medications: an Analysis From the Acute Decompensated Heart Failure National Registry (ADHERE)." Journal of the American College of Cardiology, vol. 46, no. 1, 2005, pp. 57-64.
Abraham WT, Adams KF, Fonarow GC, et al. In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the Acute Decompensated Heart Failure National Registry (ADHERE). J Am Coll Cardiol. 2005;46(1):57-64.
Abraham, W. T., Adams, K. F., Fonarow, G. C., Costanzo, M. R., Berkowitz, R. L., LeJemtel, T. H., Cheng, M. L., & Wynne, J. (2005). In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the Acute Decompensated Heart Failure National Registry (ADHERE). Journal of the American College of Cardiology, 46(1), 57-64.
Abraham WT, et al. In-hospital Mortality in Patients With Acute Decompensated Heart Failure Requiring Intravenous Vasoactive Medications: an Analysis From the Acute Decompensated Heart Failure National Registry (ADHERE). J Am Coll Cardiol. 2005 Jul 5;46(1):57-64. PubMed PMID: 15992636.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the Acute Decompensated Heart Failure National Registry (ADHERE). AU - Abraham,William T, AU - Adams,Kirkwood F, AU - Fonarow,Gregg C, AU - Costanzo,Maria Rosa, AU - Berkowitz,Robert L, AU - LeJemtel,Thierry H, AU - Cheng,Mei L, AU - Wynne,Janet, AU - ,, AU - ,, PY - 2004/09/27/received PY - 2005/03/03/revised PY - 2005/03/10/accepted PY - 2005/7/5/pubmed PY - 2005/7/29/medline PY - 2005/7/5/entrez SP - 57 EP - 64 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 46 IS - 1 N2 - 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. SN - 0735-1097 UR - https://www.unboundmedicine.com/medline/citation/15992636/In_hospital_mortality_in_patients_with_acute_decompensated_heart_failure_requiring_intravenous_vasoactive_medications:_an_analysis_from_the_Acute_Decompensated_Heart_Failure_National_Registry__ADHERE__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(05)00855-7 DB - PRIME DP - Unbound Medicine ER -