title: Nitrates for the Management of Acute Heart Failure Syndromes, A Systematic Review.
abstract: Intravenous nitrates are widely used in the management of acute heart failure syndrome (AHFS) yet with lack of robust evidence to support their use. We therefore sought to analyze all randomized studies that evaluated the effects of nitrates on clinical outcomes in patients with AHFS. In total, 15 relevant trials comparing nitrates and alternative interventions in 1824 patients were identified. All but 3 were conducted before 1998. No trials demonstrated a beneficial effect on mortality, apart from 1 trial reporting a reduction in mortality, which was related to the time of treatment. Retrospective review suggests that there is a lack of data to draw any firm conclusions concerning the use of nitrates in patients with AHFS. More studies are needed to evaluate the safety and efficacy of these agents in the modern era of guideline-directed use of heart failure therapy.
authors.affiliation: 1 Cardiology Department, Postgraduate Medical School, University of Hertfordshire, Hertfordshire, United Kingdom.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Farag
authors.affiliation: 2 Academic Cardiology Department, University of Hull, Hull, United Kingdom.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Shoaib
authors.affiliation: 1 Cardiology Department, Postgraduate Medical School, University of Hertfordshire, Hertfordshire, United Kingdom.|3 Cardiology Department, National Heart & Lung Institute, Imperial College, London, United Kingdom.
authors.forename: Diana A
authors.initials: DA
authors.lastname: Gorog
keywords: acute heart failure syndrome; morbidity; mortality; nitrates; vasodilator therapy