期刊
EUROPEAN JOURNAL OF HEART FAILURE
卷 20, 期 2, 页码 332-341出版社
WILEY
DOI: 10.1002/ejhf.991
关键词
Acute heart failure; Inotrope; Vasopressor; Vasodilator; Prognosis; Long-term outcome
资金
- Abbott Vascular Int.
- Amgen Cardiovascular
- AstraZeneca
- Bayer AG
- Boehringer Ingelheim
- Boston Scientific
- Bristol Myers Squibb
- Pfizer Alliance
- Alliance Daiichi Sankyo Europe GmbH
- Eli Lilly and Company
- Edwards
- Gedeon Richter Plc.
- Menarini Int. Op.
- MSD-Merck Co.
- Novartis Pharma AG
- ResMed
- Sanofi
- SERVIER
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.
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