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| Pàgina inicial > Articles > Articles publicats > Early intravenous nitroglycerin use in prehospital setting and in the emergency department to treat patients with acute heart failure : |
(Hospital General Universitario de Alicante (Alacant, País Valencià)) (Hospital Universitario Central de Asturias) (Hospital Universitari de Bellvitge) (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos) (Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares) (Institut d'Investigació Biomèdica Sant Pau) (Universitat de Barcelona) (Hôpital Lariboisière, Paris, France) (INSERM U-942 (Biotherapy in the critically ill))
| Data: | 2021 |
| Resum: | Background and objective: Although recommended for the treatment of acute heart failure (AHF), the use of intravenous (IV) nitroglycerin (NTG) is supported by scarce and contradicting evidence. In the current analysis, we have assessed the impact of IV NTG administration by EMS or in emergency department (ED) on outcomes of AHF patients. Methods: We analyze AHF patients included by 45 hospitals that were delivered to ED by EMS. Patients were grouped according to whether treatment with IV NTG was started by EMS before ED admission (preED-NTG), during the ED stay (ED-NTG) or were untreated with IV NTG (no-NTG, control group). In-hospital, 30-day and 365-day all-cause mortality, prolonged hospitalization (>7 days) and 90-day post-discharge combined adverse events (ED revisit, hospitalization or death) were compared in EMS-NTG and ED-NTG respect to control group. Results: We included 8424 patients: preED-NTG = 292 (3. 5%), ED-NTG = 1159 (13. 8%) and no-NTG = 6973 (82. 7%). preED-NTG group had the most severely decompensated cases of AHF (p < 0. 001) but it had lower in-hospital (OR = 0. 724, 95%CI = 0. 459-1. 114), 30-day (HR = 0. 818, 0. 576-1. 163) and 365-day mortality (HR = 0. 692, 0. 551-0. 869) and 90-day post-discharge events (HR = 0. 795, 0. 643-0. 984) than control group. ED-NTG group had mortalities similar to control group (in-hospital: OR = 1. 164, 0. 936-1. 448; 30-day: HR = 0. 980, 0. 819-1. 174; 365-day: HR = 0. 929, 0. 830-1. 039) but significantly decreased 90-day post-discharge events (HR = 0. 870, 0. 780-0. 970). Prolonged hospitalization rate did not differ among groups. Five different analyses confirmed these findings. Conclusions: Early prehospital IV NTG administration was associated with lower mortality and post-discharge events, while IV NTG initiated in ED only improved post-discharge event rate. Further studies are needed to assess the role of early prehospital administration of IV NTG to patients with AHF. |
| Ajuts: | Instituto de Salud Carlos III PI15/01019 Instituto de Salud Carlos III PI15/00773 Instituto de Salud Carlos III PI18/00393 Instituto de Salud Carlos III PI18/00456 Agència de Gestió d'Ajuts Universitaris i de Recerca SGR 2009/1385 Agència de Gestió d'Ajuts Universitaris i de Recerca SGR 2014/0313 Agència de Gestió d'Ajuts Universitaris i de Recerca 2017/1424 |
| Nota: | Altres ajuts: Ministerio de Sanidad; Fondo Europeo de Desarrollo Regional (FEDER); Fundació La Marató de TV3 (2015/2510). |
| Drets: | Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.  |
| Llengua: | Anglès |
| Document: | Article ; recerca ; Versió publicada |
| Matèria: | Acute heart failure ; Nitrates ; Nitroglycerine ; Outcome ; Mortality |
| Publicat a: | International Journal of Cardiology, Vol. 344 (january 2021) , p. 127-134, ISSN 1874-1754 |
