Long-term safety of intravenous cardiovascular agents in acute heart failure: results from the European Society of Cardiology Heart Failure Long-Term Registry
Por:
Mebazaa, A, Motiejunaite, J, Gayat, E, Crespo-Leiro, MG, Lund, LH, Maggioni, AP, Chioncel, O, Akiyama, E, Harjola, VP, Seferovic, P, Laroche, C, Julve, MS, Roig, E, Ruschitzka, F, Filippatos, G, ESC Heart Failure Long-Term Regist
Publicada:
1 feb 2018
Resumen:
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.
Filiaciones:
Mebazaa, A:
BIOmarkers CArdioNeuroVASc Dis, INSERM U942, Paris, France
St Louis Lariboisiere Hosp, AP HP, Dept Anesthesiol & Crit Care, Paris, France
Univ Paris Diderot, Paris, France
Motiejunaite, J:
BIOmarkers CArdioNeuroVASc Dis, INSERM U942, Paris, France
St Louis Lariboisiere Hosp, AP HP, Dept Anesthesiol & Crit Care, Paris, France
Lithuanian Univ Hlth Sci, Hosp Kaunas Clin, Dept Cardiol, Kaunas, Lithuania
Gayat, E:
BIOmarkers CArdioNeuroVASc Dis, INSERM U942, Paris, France
St Louis Lariboisiere Hosp, AP HP, Dept Anesthesiol & Crit Care, Paris, France
Univ Paris Diderot, Paris, France
Crespo-Leiro, MG:
CHUAC, Unidad Insuficiencia Cardiaca Avanzada & Trasplan, La Coruna, Spain
CHUAC, Inst Invest Biomed A Coruna INIBIC, La Coruna, Spain
Lund, LH:
Karolinska Univ Hosp, Karolinska Inst Heart & Vasc Theme, Dept Med, Stockholm, Sweden
Maggioni, AP:
ANMCO Res Ctr, Florence, Italy
Chioncel, O:
Univ Med & Pharm Carol Davila, Inst Urgent Boli Cardiovasc CC Iliescu, Bucharest, Romania
Akiyama, E:
BIOmarkers CArdioNeuroVASc Dis, INSERM U942, Paris, France
Yokohama City Univ, Med Ctr, Div Cardiol, Yokohama, Kanagawa, Japan
Harjola, VP:
Univ Helsinki, Helsinki Univ Hosp, Dept Emergency Care & Serv, Emergency Med, Helsinki, Finland
Seferovic, P:
Clin Ctr Serbia, Dept Cardiol, Belgrade, Serbia
Laroche, C:
European Soc Cardiol, EURObservat Res Programme, Sophia Antipolis, France
Julve, MS:
Hosp Miguel Servet, Cardiol Dept, Zaragoza, Spain
Roig, E:
Hosp Santa Creu & Sant Pau, Heart Failure & Transplantat Unit, Dept Cardiol, Barcelona, Spain
Ruschitzka, F:
Univ Heart Ctr Zurich, Heart Failure Clin & Transplantat, Dept Cardiol, Zurich, Switzerland
Filippatos, G:
Athens Univ Hosp Attikon, Athens, Greece
Bronze
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