Oral Vasodilator Protocol among Advanced Decompensated Heart Failure Patients Managed with Intravenous Vasodilator Therapy

Abstract

Background Intravenous vasodilators, including sodium nitroprusside (ISN), are recommendations for the management of acute decompensated heart failure (ADHF). Optimization of the transition from intravenous to oral vasodilators may decrease the need for intensive care and shorten length of stay. Methods Single center, retrospective study of 307 patients with ADHF, EF ( Results During the study period, the majority of patients were male (77%), average ejection fraction was 21 ± 8% and one in three patients had moderate or severe mitral regurgitation. Following availability of an oral vasodilator protocol, 58 (27%) of patients were treated on protocol. There were no significant differences in patient characteristics between those patients in the pre-protocol period compared with patients in the post-protocol time period. Compared with patients managed prior to the protocol availability, there was no significant change in CCU length of stay, total ISN use, or in-hospital mortality in the post-protocol period. In exploratory analyses of patients on-protocol with those off-protocol following protocol availability, there were no significant differences in patient characteristics or patient outcomes. ( Table 1 ) Conclusions In this series of consecutive patients with ADHF, a vasodilator protocol did not affect the CCU LOS, total ISN use or readmission rate at 30 days. However, uptake of the protocol was low overall and may reflect complexity of advanced heart failure management and provider acceptance of the protocol. These findings emphasize the need to further address penetrance of a vasodilator wean protocol and potential impact on patient outcomes.