title: Underutilization of IV nitrates in the treatment of acute heart failure.
abstract: Acute heart failure (AHF) is a growing public health concern with high inhospital mortality and costs. Clinical practice guidelines, underpinned by positive randomized controlled trials, recommend the early use of intravenous (IV) nitrates in the treatment of AHF. However, the "real-world" usage of IV nitrates has not been clearly defined. The objective of this study was to examine the use of IV nitrates in the treatment of AHF as recommended by clinical practice guidelines. A case-record analysis was conducted of all admissions with AHF at a large teaching hospital. Of the 81 AHF patients (mean age 77 ± 11, mean SBP 130 ± 27 mmHg) enrolled for this analysis, only 5 (6%) received IV nitrates at the time of AHF admission. Forty (49%, mean age 77 ± 11, mean SBP 131 ± 27 mmHg) of these 81 patients met the guideline criteria for suitability for IV nitrates and only 5 (12%) of these received them during this admission. Patients who received IV nitrates were more likely to have higher blood pressure and all had myocardial ischemia as a precipitant. Seventy-five (93%) of the total population received loop diuretics on admission. Overall, this study shows that loop diuretics remain the first-line therapy in AHF with little use of IV nitrates, despite recommendations from clinical practice guidelines.
authors.affiliation: Division of Cardiovascular & Diabetes Medicine, Ninewells Hospital & Medical School, Dundee, Angus, UK.
authors.forename: Mohapradeep
authors.initials: M
authors.lastname: Mohan
authors.affiliation: Division of Cardiovascular & Diabetes Medicine, Ninewells Hospital & Medical School, Dundee, Angus, UK.
authors.forename: Sean
authors.initials: S
authors.lastname: Hawkey
authors.affiliation: Division of Cardiovascular & Diabetes Medicine, Ninewells Hospital & Medical School, Dundee, Angus, UK.
authors.forename: Fatima
authors.initials: F
authors.lastname: Baig
authors.affiliation: Division of Cardiovascular & Diabetes Medicine, Ninewells Hospital & Medical School, Dundee, Angus, UK.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Choy
authors.affiliation: Division of Cardiovascular & Diabetes Medicine, Ninewells Hospital & Medical School, Dundee, Angus, UK.
authors.forename: Chim C
authors.initials: CC
authors.lastname: Lang
mesh_terms: D000208:Acute Disease; D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D017723:Drug Utilization Review; D005260:Female; D019983:Guideline Adherence / Q000639:trends; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D009566:Nitrates / Q000008:administration & dosage* / Q000009:adverse effects; D010343:Patient Admission; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D009566:Nitrates; D049994:Sodium Potassium Chloride Symporter Inhibitors; D014665:Vasodilator Agents
keywords: Acute heart failure; European society of cardiology; IV nitrates; Loop diuretics