The effect of intravenous isosorbide dinitrate in acute decompensated heart failure in hospital

Abstract

Background According to new recommendations for the management of acute decompensated heart failure (ADHF) in 2015, intravenous vasodilator therapy might be given as an early therapy when systolic blood pressure is normal to high (≥110 mmHg). Only 29% of patients with ADHF are treated with vasodilators without medical contraindication. Objective To evaluate the effect of the systematic use of ISDN on ADHF without contraindication especially on rehospitalization rate. Settings The 600-bed hospital (Centre Hospitalier de l'Ouest Vosgien, Neufchâteau, France). Methods This is a retrospective study with data analysed from medical records. Patients with ADHF episodes and hospitalization in the cardiology department or intensive care unit (ICU) between November 2013 and December 2015 were included resulting in 199 hospitalizations in the analysis (37 were treated by ISDN, and 162 were not). Main outcome measure Effects of ISDN on 180-day hospital readmission for ADHF or acute myocardial infarction (AMI), in-hospital mortality, length of stay, number of ICU admissions, and ICU length of stay. Results Patients who received ISDN required more ICU admissions than the other patients (54.1 vs 33.3%, p = 0.02). Nevertheless 180-day hospital readmission was lower for patients who were receiving ISDN (8.1 vs 22.8%, p = 0.04). ISDN did not influence other clinical outcomes tested. Conclusion ISDN may minimize or prevent the consequences of altered haemodynamics. Lower rehospitalization rate with ISDN was seen in this study.

A novel soluble guanylate cyclase activator with reduced risk of hypotension by short‐acting vasodilation

“…However, the improper use of diuretics causes renal dysfunction and electrolyte abnormalities during clinical acute heart failure . In recent years, the contribution of congestion due to a redistribution of circulating blood has been shown to contribute to clinical pulmonary edema, and initial treatment using a vasodilator is recommended for cases of adaptation . In clinical heart failure, vascular endothelial dysfunction is often seen, and the bioavailability of NO is decreased .…”

“…35,36 In recent years, the contribution of congestion due to a redistribution of circulating blood has been shown to contribute to clinical pulmonary edema, and initial treatment using a vasodilator is recommended for cases of adaptation. 37,38 In clinical heart failure, vascular endothelial dysfunction is often seen, and the bioavailability of NO is decreased. 39,40 Use of a sGC activator, which is an endothelial-functionimproving agent that is independent of NO, is considered reasonable in treating ADHF, if hypotension can be avoided by appropriate use.…”