title: Temporal trends in nitrate utilization for acute heart failure in elderly emergency patients: A single-centre observational study.
abstract: BACKGROUND
  We previously conducted a pilot study that reported the safety of isosorbide dinitrate boluses for elderly emergency patients with acute heart failure syndrome.
  
  
  OBJECTIVE
  To assess the temporal trend in the rate of elderly patients treated with isosorbide dinitrate, and to evaluate subsequent outcome differences.
  
  
  METHODS
  This was a single-centre study. We compared patients aged>75 years who attended the emergency department with a primary diagnosis of acute pulmonary oedema in the years 2007 and 2014. The primary endpoint was the rate of patients who received isosorbide dinitrate boluses in the emergency department. Secondary endpoints included in-hospital mortality, need for intensive care and length of stay.
  
  
  RESULTS
  We analysed 368 charts, 232 from patients included in 2014 (63%) and 136 in 2007 (37%). The mean age was 85±6 years in both groups. There was a significant rise in the rate of patients treated with isosorbide dinitrate between 2007 and 2014: 97 patients (42%) in 2014 vs. 24 patients (18%) in 2007 (P<0.01). Comparing the two periods, we report similar in-hospital mortality rates (8% vs. 11%; P=0.5), rates of admission to the intensive care unit (13% vs. 17%; P=0.3) and lengths of stay (10 days in both groups).
  
  
  CONCLUSIONS
  We observed a significant rise in the rate of elderly patients treated with isosorbide dinitrate boluses for acute heart failure. However, we did not observe any significant improvement in outcomes.
authors.affiliation: Emergency Department, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
authors.forename: Najla
authors.initials: N
authors.lastname: Lemachatti
authors.affiliation: Emergency Department, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Paris Sorbonne Université, UPMC Université Paris 6, UMRS Inserm 1166, IHU ICAN, 75013 Paris, France.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Philippon
authors.affiliation: Queen Mary University, London, UK.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Bloom
authors.affiliation: Emergency Department, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Paris Sorbonne Université, UPMC Université Paris 6, UMRS Inserm 1166, IHU ICAN, 75013 Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Hausfater
authors.affiliation: Emergency Department, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Paris Sorbonne Université, UPMC Université Paris 6, UMRS Inserm 1166, IHU ICAN, 75013 Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Riou
authors.affiliation: Paris Sorbonne Université, UPMC Université Paris 6, UMRS Inserm 1166, IHU ICAN, 75013 Paris, France; Emergency Department, Hôpital Tenon, AP-HP, 75020 Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Ray
authors.affiliation: Emergency Department, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Paris Sorbonne Université, UPMC Université Paris 6, UMRS Inserm 1166, IHU ICAN, 75013 Paris, France. Electronic address: yonatman@gmail.com.
authors.forename: Yonathan
authors.initials: Y
authors.lastname: Freund
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D004305:Dose-Response Relationship, Drug; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007275:Injections, Intravenous; D007548:Isosorbide Dinitrate / Q000008:administration & dosage*; D007902:Length of Stay / Q000639:trends; D008297:Male; D020030:Nitric Oxide Donors / Q000008:administration & dosage; D010865:Pilot Projects; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D020030:Nitric Oxide Donors; D007548:Isosorbide Dinitrate
keywords: Dinitrate d’isosorbide; Elderly; Emergency; Gériatrie; Heart failure; Insuffisance cardiaque aiguë; Isosorbide dinitrate; Nitrates; Nitrés; Urgences