Abstract
Background and objectiveAlthough recommended for the treatment of acute heart failure (AHF), the use of intravenous (IV) nitroglycerin (NTG) is supported by scarce and contradicting evidence. In the current analysis, we have assessed the impact of IV NTG administration by EMS or in emergency department (ED) on outcomes of AHF patients. MethodsWe analyze AHF patients included by 45 hospitals that were delivered to ED by EMS. Patients were grouped according to whether treatment with IV NTG was started by EMS before ED admission (preED-NTG), during the ED stay (ED-NTG) or were untreated with IV NTG (no-NTG, control group). In-hospital, 30-day and 365-day all-cause mortality, prolonged hospitalization (>7 days) and 90-day post-discharge combined adverse events (ED revisit, hospitalization or death) were compared in EMS-NTG and ED-NTG respect to control group. ResultsWe included 8424 patients: preED-NTG = 292 (3.5%), ED-NTG = 1159 (13.8%) and no-NTG = 6973 (82.7%). preED-NTG group had the most severely decompensated cases of AHF (p < 0.001) but it had lower in-hospital (OR = 0.724, 95%CI = 0.459–1.114), 30-day (HR = 0.818, 0.576–1.163) and 365-day mortality (HR = 0.692, 0.551-0.869) and 90-day post-discharge events (HR = 0.795, 0.643–0.984) than control group. ED-NTG group had mortalities similar to control group (in-hospital: OR = 1.164, 0.936–1.448; 30-day: HR = 0.980, 0.819–1.174; 365-day: HR = 0.929, 0.830–1.039) but significantly decreased 90-day post-discharge events (HR = 0.870, 0.780–0.970). Prolonged hospitalization rate did not differ among groups. Five different analyses confirmed these findings. ConclusionsEarly prehospital IV NTG administration was associated with lower mortality and post-discharge events, while IV NTG initiated in ED only improved post-discharge event rate. Further studies are needed to assess the role of early prehospital administration of IV NTG to patients with AHF.
Highlights
Introduction attending emergency department (ED) physician decisionsThe use of intravenous (IV) nitrates for the treatment of acute heart failure (AHF) has been debated
We have attempted to explore the effects of prehospital administration of nitrates on mortality and adverse events in the EAHFE (Epidemiology of AHF in Emergency departments) Spanish registry that includes patients diagnosed with AHF in emergency department (ED) consecutively included in sets of 1–2 months cohorts during last 15 years
Between EAHFE cohort 3 and cohort 6, 8424 patients who were delivered to the hospital by the emergency medical services (EMS) were prospectively enrolled into a registry
Summary
Introduction attending ED physician decisionsThe use of intravenous (IV) nitrates (nitroglycerine, NTG) for the treatment of acute heart failure (AHF) has been debated. A small study reported improved oxygenation, and reduced need for me chanical ventilation and other adverse events in patients with AHF and significant desaturation when high doses of IV nitrates were adminis tered in the prehospital setting [1]. This was followed by a more generalized recommendation in the guidelines for the treatment of AHF for the use of IV nitrates for longer periods of time in the in-hospital setting during the first days of admission for AHF [2,3].
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