For the study, 15,230 patients in the registry received one or more of the four drugs. Nitroglycerin was given to 6,549 patients, nesiritide, 5,220; milrinone, 2,021; and dobutamine, 4,226. The therapies administered were based on clinician judgment, not on a randomized protocol. Another 49,950 patients in the registry did not receive any of the four drugs, presumably because their heart failure was less severely worsened.
After adjusting for differences in patient characteristics, mortality was similar for patients given nitroglycerin or nesiritide, while patients given milrinone or dobutamine experienced an approximately 35 percent to 50 percent increase in the chance of dying in the hospital. Between the latter two agents, dobutamine was associated with higher in-hospital mortality than milrinone.
"Our study suggests that inotropes be reserved for patients who fail with vasodilators or are so severely ill that vasodilators alone are likely to be inadequate treatment," said Abraham, also associate director for clinical/translational research at Ohio State's Davis Heart and Lung Research Institute.
Abraham stresses that nitroglycerin and nesiritide appear to be equally safe in the treatment of ADHF and that other criteria should be considered when choosing between the two drugs.
People with this life-threatening degree of heart failure are usually treated in a hospital setting due to the severity of their illness and the intensity of their treatment. While guidelines exist for treating outpatients with chronic heart failure, a lack of statistical data has prevented similar guidelines from being established for ADHF.
Creation in 2001 of the Acute Decompensated Heart Failure National Registry (ADHERE) has helped coordinate and expedite the collection of data from more than 275 hospitals from across the country. The registry is the
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Contact: David Crawford
crawford.1@osu.edu
614-293-3737
Ohio State University Medical Center
4-Jul-2005