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

Mebazaa, Alexandre; Parissis, John; Porcher, Raphaël; Gayat, Étienne; Nikolaou, Maria; Boas, Fabio Vilas; Delgado, Juan; Folláth, Ferenc

doi:10.1007/s00134-010-2073-4

Cited by 203 publications

(167 citation statements)

References 42 publications

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“…The results of this study alone, given the lack of a strong statistically significant result, and the poor methodological quality of the included studies, may not be sufficient to drive a change in clinical practice. It should be noted that the results of this study are in accord with large observational studies that have also suggested harm associated with use of dobutamine in patients with severe heart failure [47,48]. Taken together, this evidence should cause clinicians to reconsider their use of dobutamine in patients with heart failure, particularly those most at risk of the adverse effects, those with underlying ischaemic heart disease.…”

Section: Nrsupporting

confidence: 78%

Dobutamine for patients with severe heart failure: a systematic review and meta-analysis of randomised controlled trials

2011

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Purpose: Dobutamine is recommended for patients with severe heart failure; however uncertainty exists as to its effect on mortality. This study aims to critically review the literature to evaluate whether dobutamine, compared with placebo or standard care, is associated with lower mortality and a range of secondary outcomes, in patients with severe heart failure. Methods: A systematic review and meta-analysis of randomised controlled trials was performed. PubMed, EMBASE, the Cochrane Central Trials Registry, the metaRegister of Controlled Trials and bibliographies of retrieved articles were searched. Randomised trials comparing dobutamine with placebo or standard care, in human, adult patients with severe heart failure, were included if they reported at least one outcome of interest. Data regarding trial validity, methodological processes and clinical outcomes were extracted, and a meta-analysis was performed. Results: Fourteen studies, with 673 participants, met the inclusion criteria and were included; 13 studies reported mortality. There was minimal heterogeneity (I 2 = 4.5%). The estimate of the odds ratio for mortality for patients with severe heart failure treated with dobutamine compared with standard care or placebo was 1.47 (95% confidence interval 0.98-2.21, p = 0.06).Conclusions: This meta-analysis showed that dobutamine is not associated with improved mortality in patients with heart failure, and there is a suggestion of increased mortality associated with its use, although this did not reach the conventional level of statistical significance. Further research to define the role of dobutamine in treatment of severe heart failure should be a priority.

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Section: Nrsupporting

confidence: 78%

Dobutamine for patients with severe heart failure: a systematic review and meta-analysis of randomised controlled trials

2011

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“…i obserwacji oDległej w okresie zwiększonego ryzyka Pacjenci przyjęci z AHF mogą zostać wypisani do domu [552]:…”

Section: Kryteria Wypisywania Ze Szpitalaunclassified

ESC Guidelines for the Diagnosis And Treatment of Acute And Chronic Heart Failure 2008

Dickstein¹,

Cohen‐Solal²,

Filippatos³

et al. 2008

Revista Española de Cardiología (English Edition)

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“…Observational data have demonstrated that titrated nitroprusside with conversion to combinational treatment with oral hydralazine and nitrates is feasible and potentially associated with better outcomes in advanced decompen- sated HF patients with low cardiac output who are normo-or hypertensive [50,51] . Afterload reduction in decompensated HF is further supported by a retrospective analysis of 4,953 patients, which used propensity-matching to demonstrate improved survival with vasodilator therapy versus increased mortality with inotrope therapy [52] . However, it is worth mentioning that the notion of increased mortality with inotropes mainly comes from data with β-agonists (i.e., dopamine and dobutamine) and phosphodiesterase-3 inhibitors (i.e., milrinone), with a potentially better safety profile of the calcium-sensitizer levosimendan, making the latter the preferred inotrope to use in decompensated HF patients with low cardiac output and arterial hypotension [48,49,53] .…”

Section: Increasing the Effective Circulatory Volumementioning

confidence: 99%

Management of the Cardiorenal Syndrome in Decompensated Heart Failure

2014

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Background:The management of the cardiorenal syndrome (CRS) in decompensated heart failure (HF) is challenging, with high-quality evidence lacking. Summary: The pathophysiology of CRS in decompensated HF is complex, with glomerular filtration rate (GFR) and urine output representing different aspects of kidney function. GFR depends on structural factors (number of functional nephrons and integrity of the glomerular membrane) versus hemodynamic alterations (volume status, renal perfusion, arterial blood pressure, central venous pressure or intra-abdominal pressure) and neurohumoral activation. In contrast, urine output and volume homeostasis are mainly a function of the renal tubules. Treatment of CRS in decompensated HF patients should be individualized based on the underlying pathophysiological processes. Key Messages: Congestion, defined as elevated cardiac filling pressures, is not a surrogate for volume overload. Transient decreases in GFR might be accepted during decongestion, but hypotension must be avoided. Paracentesis and compression therapy are essential to remove fluid overload from third spaces. Increasing the effective circulatory volume improves renal function when cardiac output is depressed. As mechanical support is invasive and inotropes are related to increased mortality, afterload reduction through vasodilator therapy remains the preferred strategy in patients who are normo-or hypertensive. Specific therapies to augment renal perfusion (rolofylline, dopamine or nesiritide) have rendered disappointing results, but recently, serelaxin has been shown to improve renal function, even with a trend towards reduced all-cause mortality in selected patients. Diuretic resistance is associated with worse outcomes, independent of the underlying GFR. Combinational diuretic therapy, with ultrafiltration as a bail-out strategy, is indicated in case of diuretic resistance.

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

Abstract: In terms of in-hospital survival, a vasodilator in combination with a diuretic fared better than treatment with only a diuretic. Catecholamine inotropes should be used cautiously as it has been seen that they actually increase the risk for in-hospital mortality.

Cited by 203 publications

References 42 publications

Dobutamine for patients with severe heart failure: a systematic review and meta-analysis of randomised controlled trials

Dobutamine for patients with severe heart failure: a systematic review and meta-analysis of randomised controlled trials

ESC Guidelines for the Diagnosis And Treatment of Acute And Chronic Heart Failure 2008

Management of the Cardiorenal Syndrome in Decompensated Heart Failure

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