title: Short-term survival by treatment among patients hospitalized with acute heart failure: the global ALARM-HF registry using propensity scoring methods.
abstract: OBJECTIVE
  To date, treatment with intravenous (IV) agents such as vasodilators, diuretics, and inotropes has shown marginal or mixed benefits in acute heart failure (AHF) trials. The aim of this study was to identify the risks and benefits of IV drugs in patients hospitalized with acute decompensated heart failure.
  
  
  METHODS
  The AHF global survey of standard treatment (ALARM-HF) reviewed in-hospital treatments in eight countries. The present study was a post hoc analysis of ALARM-HF data in which propensity scoring was used to identify groups of patients who differed by treatment but had the same multivariate distribution of covariates. Such propensity matching allowed estimations of the effect of specific treatments on the outcome of in-hospital mortality.
  
  
  RESULTS
  Unadjusted analysis showed a lower in-hospital mortality rate in AHF patients receiving "diuretics + vasodilators" (n = 1,805) compared to those receiving "diuretics alone" (n = 2,362) (7.6 vs. 14.2%, p < 0.0001). Propensity-based matching (n = 1,007 matched pairs) confirmed the lower mortality of AHF patients receiving diuretics + vasodilators: 7.8 versus 11.0% (p = 0.016). Unadjusted analysis showed a much greater in-hospital mortality rate in patients receiving IV inotropes (25.9%) compared to those who did not (5.2%) (p < 0.0001). Propensity-based matching (n = 954 pairs) confirmed that IV catecholamine use was associated with 1.5-fold increase for dopamine or dobutamine use and a >2.5-fold increase for norepinephrine or epinephrine use.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Hôpital Lariboisère, L'Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France. alexandre.mebazaa@lrb.aphp.fr
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.forename: John
authors.initials: J
authors.lastname: Parissis
authors.forename: Raphael
authors.initials: R
authors.lastname: Porcher
authors.forename: Etienne
authors.initials: E
authors.lastname: Gayat
authors.forename: Maria
authors.initials: M
authors.lastname: Nikolaou
authors.forename: Fabio Vilas
authors.initials: FV
authors.lastname: Boas
authors.forename: J F
authors.initials: JF
authors.lastname: Delgado
authors.forename: Ferenc
authors.initials: F
authors.lastname: Follath
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019538:Health Care Surveys; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012042:Registries; D016019:Survival Analysis; D055815:Young Adult