Long‐term safety of intravenous cardiovascular agents in acute heart failure: results from the European Society of Cardiology Heart Failure Long‐Term Registry

Abstract

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.

Inotropes and vasopressors in acute heart failure, when the devil dresses as an angel

“…The authors concluded that vasodilators did not demonstrate any association with long‐term clinical outcomes, while inotropes and/or vasopressors were associated with an increased risk of all‐cause mortality, mainly related to an excess in in‐hospital mortality. It is of note that these results were confirmed in each of the countries participating in the registry . To minimize clinical differences amongst patients treated with or without i.v.…”

“…The second and more complex question is: ‘Why are inotropes harmful?’ In the present paper, Mebazaa et al . do not comment about the possible mechanisms that could explain the detrimental effect of inotropes in patients with acute HF .…”

“…In the present study, Mebazaa et al . report the results of an investigation that included 6926 patients admitted for unscheduled hospitalization for acute HF.…”

Highlights in heart failure

“…246 BMS-986231, a novel second-generation nitroxyl donor with potential inotropic, lusitropic and vasodilatory effects in patients hospitalized with decompensated heart failure and reduced ejection fraction (HFrEF), was safe and had beneficial haemodynamic effects. 246 BMS-986231, a novel second-generation nitroxyl donor with potential inotropic, lusitropic and vasodilatory effects in patients hospitalized with decompensated heart failure and reduced ejection fraction (HFrEF), was safe and had beneficial haemodynamic effects.…”

February 2018 at a glance: heart and brain interaction, prognostic variables, and acute heart failure and post‐discharge outcomes

“…Two studies, both conducted using a propensity matching approach, show the different significance of intravenous and oral therapies in patients admitted for acute HF. An analysis of 6926 patients hospitalized for acute HF in the ESC‐HF‐Long Term Registry reported that intravenous diuretics and/or vasodilators were not associated with in‐hospital or long‐term outcomes, whereas the use of intravenous inotropes and/or vasopressors was associated increased in‐hospital and long‐term mortality rates (HR 1.873, 95% CI 1.151–3.048 and HR 1.434, 95% CI 1.128–1.823, respectively) . This association between intravenous inotropes/vasopressors and outcomes was lost when only the patients discharged alive were analysed, suggesting that intravenous agents may affect only the short‐term outcomes …”