title: Is addition of vasodilators to loop diuretics of value in the care of hospitalized acute heart failure patients? Real-world evidence from a retrospective analysis of a large United States hospital database.
abstract: BACKGROUND
  Current guidelines recommend the use of intravenous (IV) vasodilators in addition to IV loop diuretics for the treatment of acute heart failure (AHF) patients without hypotension. The evidence basis for these recommendations is limited.
  
  
  RESULTS
  Hospital billing records for 82,808 AHF patients in the United States were analyzed. Patients receiving IV loop diuretics alone were paired with patients receiving IV loop diuretics + IV nitrates or IV nesiritide with the use of propensity score matching, excluding those with hypotension and/or evidence of cardiogenic shock, myocardial infarction, or acute coronary syndrome. Compared with paired patients receiving IV loop diuretics alone, in-hospital mortality was similar among IV loop diuretics + IV nitrates patients (n = 4,401; 1.9% vs 2.0%; P = .88) and marginally higher for IV loop diuretics + IV nesiritide patients (n = 2,254; 2.2% vs 3.1%; P = .05). Compared with paired IV loop diuretics patients, IV loop diuretics + IV nitrates or IV nesiritide had longer lengths of stay (+1.6 and +2.1 days; P < .01) and 57% higher costs (P < .01).
  
  
  CONCLUSIONS
  Among hospitalized AHF patients, the addition of IV vasodilators to IV loop diuretics did not lower inpatient mortality or rehospitalization rates compared with loop diuretics alone, and was associated with longer lengths of stay and higher hospitalization costs. Although the lack of complete clinical, socioeconomic, and post-discharge data may have confounded these results, this analysis questions whether currently available IV vasodilators can improve outcomes in hospitalized AHF patients.
authors.affiliation: Professor of Medicine. Electronic address: gradmana@temple.edu.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Gradman
authors.affiliation: Analysis Group, Montreal, Ontario, Canada.
authors.forename: Francis
authors.initials: F
authors.lastname: Vekeman
authors.affiliation: Analysis Group, Boston, Massachusetts.
authors.forename: Adi
authors.initials: A
authors.lastname: Eldar-Lissai
authors.affiliation: Analysis Group, Boston, Massachusetts.
authors.forename: Alex
authors.initials: A
authors.lastname: Trahey
authors.affiliation: Novartis Pharma, Basel, Switzerland.
authors.forename: Siew Hwa
authors.initials: SH
authors.lastname: Ong
authors.affiliation: Analysis Group, Boston, Massachusetts.
authors.forename: Mei Sheng
authors.initials: MS
authors.lastname: Duh
mesh_terms: D000208:Acute Disease; D000368:Aged; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D049994:Sodium Potassium Chloride Symporter Inhibitors; D014665:Vasodilator Agents
keywords: Acute heart failure; claims data; hospital length of stay; hospitalization costs; nitrates