Management of acute heart failure and the effect of systolic blood pressure on the use of intravenous therapies.
OBJECTIVE
To examine the use of the treatments for acute heart failure (AHF) recommended by ESC guidelines in different clinical presentations and blood pressure groups.


METHODS
The use of intravenous diuretics, nitrates, opioids, inotropes, and vasopressors as well as non-invasive ventilation (NIV) was analysed in 620 patients hospitalized due to AHF. The relation between AHF therapies and clinical presentation, especially systolic blood pressure (SBP) on admission, was also assessed.


RESULTS
Overall, 76% of patients received i.v. furosemide, 42% nitrates, 29% opioids, 5% inotropes and 7% vasopressors, and 24% of patients were treated with NIV. Furosemide was the most common treatment in all clinical classes and irrespective of SBP on admission. Nitrates were given most often in pulmonary oedema and hypertensive AHF. Overall, only SBP differed significantly between patients with and without the studied treatments. SBP was higher in patients treated with nitrates than in those who were not (156 vs. 141 mmHg, p<0.001). Still, only one-third of patients presenting acute decompensated heart failure and SBP over 120 mmHg were given nitrates. Inotropes and vasopressors were given most frequently in cardiogenic shock and pulmonary oedema, and their use was inversely related to initial SBP (p<0.001). NIV was used only in half of the cardiogenic shock and pulmonary oedema patients.


CONCLUSIONS
The management of AHF differs between ESC clinical classes and the use of i.v. vasoactive therapies is related to the initial SBP. However, there seems to be room for improvement in administration of vasodilators and NIV.
Helsinki University Central Hospital, Helsinki, Finland.
Tuukka
T
Tarvasmäki
Veli-Pekka
VP
Harjola
Jukka
J
Tolonen
Krista
K
Siirilä-Waris
Markku S
MS
Nieminen
Johan
J
Lassus
D000208:Acute Disease; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D001794:Blood Pressure / Q000502:physiology*; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D002908:Chronic Disease; D018450:Disease Progression; D004232:Diuretics / Q000008:administration & dosage; D005260:Female; D005665:Furosemide / Q000008:administration & dosage; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D006973:Hypertension / Q000150:complications; D007262:Infusions, Intravenous; D008297:Male; D009566:Nitrates / Q000008:administration & dosage; D017410:Practice Guidelines as Topic; D011654:Pulmonary Edema / Q000150:complications; D012121:Respiration, Artificial / Q000379:methods*; D012770:Shock, Cardiogenic / Q000150:complications; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D018497:Ventricular Dysfunction, Right / Q000150:complications
D000701:Analgesics, Opioid; D002316:Cardiotonic Agents; D004232:Diuretics; D009566:Nitrates; D014662:Vasoconstrictor Agents; D005665:Furosemide
Acute heart failure; intravenous; management; medical therapy; systolic blood pressure