Underutilization of IV nitrates in the treatment of acute heart failure.

Abstract

Acute heart failure (AHF) is a growing public health concern with high inhospital mortality and costs. Clinical practice guidelines, underpinned by positive randomized controlled trials, recommend the early use of intravenous (IV) nitrates in the treatment of AHF. However, the "real-world" usage of IV nitrates has not been clearly defined. The objective of this study was to examine the use of IV nitrates in the treatment of AHF as recommended by clinical practice guidelines. A case-record analysis was conducted of all admissions with AHF at a large teaching hospital. Of the 81 AHF patients (mean age 77 ± 11, mean SBP 130 ± 27 mmHg) enrolled for this analysis, only 5 (6%) received IV nitrates at the time of AHF admission. Forty (49%, mean age 77 ± 11, mean SBP 131 ± 27 mmHg) of these 81 patients met the guideline criteria for suitability for IV nitrates and only 5 (12%) of these received them during this admission. Patients who received IV nitrates were more likely to have higher blood pressure and all had myocardial ischemia as a precipitant. Seventy-five (93%) of the total population received loop diuretics on admission. Overall, this study shows that loop diuretics remain the first-line therapy in AHF with little use of IV nitrates, despite recommendations from clinical practice guidelines.

• Authors: Mohapradeep Mohan, Sean Hawkey, Fatima Baig, Anna Maria Choy, Chim C Lang
• Journal: Cardiovascular therapeutics (Cardiovasc Ther) Vol. 33 Issue 4 Pg. 247-52 (Aug 2015) ISSN: 1755-5922 [Electronic] England
• PMID: 25981786 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 John Wiley & Sons Ltd.

Chemical References

• Nitrates
• Sodium Potassium Chloride Symporter Inhibitors
• Vasodilator Agents

Topics

• Acute Disease
• Administration, Intravenous
• Aged
• Aged, 80 and over
• Comorbidity
• Drug Utilization Review
• Female
• Guideline Adherence (trends)
• Heart Failure (diagnosis, drug therapy, epidemiology, physiopathology)
• Hospitals, Teaching
• Humans
• Male
• Nitrates (administration & dosage, adverse effects)
• Patient Admission
• Practice Guidelines as Topic
• Practice Patterns, Physicians' (trends)
• Prospective Studies
• Retrospective Studies
• Risk Factors
• Scotland (epidemiology)
• Sodium Potassium Chloride Symporter Inhibitors (administration & dosage)
• Time Factors
• Treatment Outcome
• Vasodilator Agents (administration & dosage, adverse effects)