Impact of a high‐dose nitrate strategy on cardiac stress in acute heart failure: a pilot study

“…Levy et al found that patients who received high‐dose nitroglycerin experienced decreased need for intubation, noninvasive mechanical ventilation, and ICU admission 14. Reduced need for mechanical ventilation was also found by Cotter et al,24 although this finding was not observed to be significant by Breidthardt et al 25. However, despite the above, mortality is a clinically important outcome, which was not demonstrably improved in any of the aforementioned smaller studies and also in our present evaluation.…”

Section: Discussionmentioning

confidence: 88%

“…However, the study was terminated prematurely and a total of 2 deaths occurred during the study, limiting its inference in relation to survival benefit. Lastly, Breidthardt et al demonstrated in 128 patients that high‐dose nitrates accelerated improvement in serial brain natriuretic peptide measurements, but they found no effect on clinical outcomes including mortality, length of stay, or 90‐day rehospitalization rates 25. The caveat in interpretation of the aforementioned trial is that there were only 20 deaths in the entire study 25.…”

Section: Discussionmentioning

confidence: 99%

Impact of Nitrate Use on Survival in Acute Heart Failure: A Propensity‐Matched Analysis

Parker

Austin

et al. 2016

JAHA

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BackgroundThere is limited evidence that the use of nitrates in acute decompensated heart failure early after presentation to a hospital can improve clinical outcomes. We aimed to determine whether early nitrate exposure is associated with improved survival in a large retrospective cohort study.Methods and ResultsWe examined 11 078 acute decompensated heart failure patients who presented to emergency departments in Ontario, Canada, between 2004 and 2007, in the Enhanced Feedback For Effective Cardiac Treatment and the Emergency Heart failure Mortality Risk Grade studies. In propensity‐matched analyses, we examined the effect of nitrate administration in the acute emergency department setting for its impact on death at 7, 30, and 365 days. In propensity‐matched analyses, we found no difference in survival between those who received nitrates in the emergency department and the non‐nitrate comparator group. Hazard ratios for mortality were 0.76 (95% CI; 0.51, 1.12) over 7 days, 0.97 (95% CI; 0.77, 1.21) over 30 days, and 0.91 (95% CI; 0.82, 1.02) over 1 year of follow‐up. There was no significant difference in survival or hospital length of stay between nitrate and non‐nitrate controls in extended follow‐up. There was also no significant effect of nitrates in subgroups stratified by presence of chest pain, troponin elevation, chronic nitrate use, and known coronary artery disease.ConclusionsIn acute decompensated heart failure, use of nitrates acutely in the emergency department setting was not associated with improvement in short‐term or near‐term survival. Our study does not support generalized use of nitrates when the primary goal of therapy is to reduce mortality.

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“…Recently, Breidthardt showed that sublingual and transdermal nitrates had an improving effect on the mortality in patients with acute HF. Breidthardt showed that high-dose sublingual or transdermal nitrate on top of standard HF therapy was safe and accelerated cardiac recovery (20). In another study, it was found that IV nitrate improved cardiac function in patients with acute HF due to severe aortic stenosis (21), in which vasodilators are generally thought to be contraindicated.…”

Section: Discussionmentioning

confidence: 92%

Effect of intravenous nitrate treatment on serum BNP level and 30-day follow-up events in decompensated systolic heart failure

Topuz¹,

Kaplan²

2018

Eur J Ther

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Objective: The aim of this study was to evaluate the potential of intravenous (IV) nitroglycerine (NTG) administration to accelerate the reduction of B-type natriuretic peptide (BNP) levels in patients with decompensated systolic heart failure (HF) and to evaluate its impact on follow-up events. Methods: A total of 165 patients with systolic HF who were hospitalized due to acute decompensation were enrolled into the current study. Study patients were divided into two groups. Patients who were receiving standard HF therapy (angiotensin-converting enzyme [ACE] or angiotensin receptor blocker [ARB], beta-blockers, loop diuretics, and anticoagulant or anti-aggregant agents for venous prophylaxis) were categorized as the standard HF therapy group (n=72), and patients receiving a standard dose of IV NTG in addition to standard HF therapy were categorized as the IV NTG group (n=93). BNP levels and blood gas analyses were measured at admission and after 48 h; all patients were followed up along the first month after discharge. Results: Serum BNP levels decreased in all patients after 48 h. The decreasing of BNP level was higher and the improvement of blood gas analysis was better in the IV NTG group than in the standard therapy group (1347.1±314.3 vs. 280.0±196.2 pg/mL for the IV NTG group and 1178.3±305.5 vs. 495.4±229.9 pg/mL for the standard therapy group; p<0.001). In the multi-logistic regression analysis, serum sodium at admission, BNP level at 48 h, and use of IV NTG were found as predictors of 30-day follow-up events. Conclusion:We have shown that IV NTG therapy in addition to standard HF therapy has a markedly better effect on lowering of plasma BNP levels, improves blood gas analyses, and may reduce follow-up events in patients with systolic HF.

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Impact of a high‐dose nitrate strategy on cardiac stress in acute heart failure: a pilot study

Cited by 37 publications

References 29 publications

Short-term survival by treatment among patients hospitalized with acute heart failure: the global ALARM-HF registry using propensity scoring methods

Short-term survival by treatment among patients hospitalized with acute heart failure: the global ALARM-HF registry using propensity scoring methods

Impact of Nitrate Use on Survival in Acute Heart Failure: A Propensity‐Matched Analysis

Effect of intravenous nitrate treatment on serum BNP level and 30-day follow-up events in decompensated systolic heart failure

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