title: Influence of Intravenous Nitrate Treatment on Early Mortality Among Patients With Acute Heart Failure. NITRO-EAHFE Study.
abstract: OBJECTIVE
  There is little evidence on the prognostic influence of intravenous nitrates in patients with acute heart failure. Our purpose was to determine the influence of this treatment on early mortality and new visits.
  
  
  METHODS
  Prospective, multicenter cohort study of patients with acute heart failure in an emergency room during 2 periods (May 2009 and November-December 2011). Patients with systolic blood pressure > 110mmHg were included, grouped according to whether they received intravenous nitroglycerin or not. Endpoints were mortality at 3, 7, 14, and 30 days and new visits at 30 days. The propensity score was estimated by logistic regression to determine the prognostic influence of the treatment.
  
  
  RESULTS
  We included 3178 of 4897 individuals. A total of 308 (9.7%) had died within 30 days and 465 (17%) attended new visits. The mean (standard deviation) age was 79.5 (10.0) years, and 796 (25%) patients received intravenous nitrates. After matching, there were 685 individuals in each group. The hazard ratio for 30-day mortality with nitrates was 1.21 (95% confidence interval, 0.87-1.70) and was 0.93 for new visits (95% confidence interval, 0.71-1.22). The results were similar for mortality at 3, 7, and 14 days (hazard ratio = 1.05 [95% confidence interval, 0.56-1.96], hazard ratio = 1.20 [95% confidence interval, 0.74-1.94], and hazard ratio = 1.23 [95% confidence interval, 0.82-1.84], respectively). In the presence of hypertensive pulmonary edema, the nitrates group showed a hazard ratio of 0.88 (95% confidence interval, 0.47-1.63) for 30-day mortality.
  
  
  CONCLUSIONS
  Intravenous nitrates do not influence early mortality or new visits in patients with acute heart failure.
authors: Unidad de Gestión Clínica de Urgencias, Hospital Universitario Central de Asturias (HUCA), Grupo de Investigación de Urgencias-HUCA, Oviedo, Spain. Electronic address: pabloherrero71@hotmail.com.
authors: Pablo
authors: P
authors: Herrero-Puente
authors: Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors: Javier
authors: J
authors: Jacob
authors: Servicio de Urgencias y UCE, Hospital Clínico San Carlos, Madrid, Spain.
authors: Francisco Javier
authors: FJ
authors: Martín-Sánchez
authors: Unidad de Gestión Clínica de Urgencias, Hospital Universitario Central de Asturias (HUCA), Grupo de Investigación de Urgencias-HUCA, Oviedo, Spain.
authors: Joaquín
authors: J
authors: Vázquez-Álvarez
authors: Oficina de Investigación Biosanitaria de Asturias (OIB-FICYT), Spain and Universidad Autónoma de Chile, Chile.
authors: Pablo
authors: P
authors: Martínez-Camblor
authors: Área de Urgencias, Hospital Clinic, Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, Spain.
authors: Òscar
authors: Ò
authors: Miró
authors: Servicio de Urgencias, Hospital General Universitario de Albacete, Albacete, Spain.
authors: Francisco Javier
authors: FJ
authors: Lucas-Imbernón
authors: Área de Gestión Clínica de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors: Aleida
authors: A
authors: Martínez-Zapico
authors: Servicio de Urgencias-UCE y Hospitalización a Domicilio, Hospital Universitario General de Alicante, Alicante, Spain.
authors: Pere
authors: P
authors: Llorens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D009566:Nitrates / Q000627:therapeutic use*; D005996:Nitroglycerin / Q000627:therapeutic use*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D009566:Nitrates; D014665:Vasodilator Agents; D005996:Nitroglycerin
keywords: Acute heart failure; Hospital emergency rooms; Insuficiencia cardiaca aguda; Intravenous nitrates; Mortalidad; Mortality; Nitratos intravenosos; Propensity score; Servicios de urgencias hospitalarios