Nitrate and Diuretic Treatments in Acute Heart Failure within 30 Minutes: A Cross Sectional Study in Emergency Department

Year 2022, Volume: 44 Issue: 6, 786 - 792, 28.11.2022

Emre Çatal , Nurdan Acar , Engin Özakın , Mustafa Emin Çanakçı , Hakan Dolgun , S. Hamed Moghanchi Zadeh , Selda Murat , Yüksel Çavuşoğlu

https://doi.org/10.20515/otd.1127447

Cited By: 1

Abstract

Diuretics and nitrates form the cornerstone of emergency treatment, and more recently, some observational studies have highlighted the importance of the concept of 'time' in the treatment of Acute Heart Failure (AHF). We aimed to investigate clinical manifestations, phenotypes, and outcomes of patients with AHF and required early diuretics and nitrates administration. Patients who presented to the ED with signs and symptoms of acute heart failure were included in the study. The clinical features of the early (30 minutes and less) and delayed (over 30 minutes) treatment groups were evaluated according to the duration of diuretic and nitrate treatment. The median age of the 719 patients was 73 years [66–80 IQR] and 395 (54.9%) were male. Furosemide treatment was administered to 682 (94.9%) patients, and 537 (74.7%) patients received glycerol trinitrate treatment. In-hospital mortality rates were high in patients who received early treatments of both furosemide and nitrate (OR: 5.802, 95% CI: 1.885–17.831, p = 0.001 and OR: 5.229, 95% CI: 1.355–20.115, p = 0.013, respectively). The 3-month mortality rates were also high in patients who received early furosemide treatment (OR: 1.864, 95% CI: 1.078–3.223, p = 0.026). Patients who were started diuretics and nitrates in the early period (<30 min) had shorter stays in the ED. In-hospital mortality was higher in early treatment group.

Keywords

heart failure, furosemide, nitrates, emergency department

Akut Kalp Yetersizliğinde İlk 30 Dakika İçinde Nitrat ve Diüretik Tedavileri: Acil Serviste Kesitsel Bir Çalışma

Abstract

Akut Kalp Yetmezliğinin (AKY) tedavisinde diüretikler ve nitratlar, acil tedavinin temel taşını oluşturur ve yakın zamanlarda, bazı gözlemsel çalışmalar, 'zaman' kavramının önemini vurgulamıştır. AKY bulunan, erken diüretik ve nitrat uygulaması gerektiren hastaların klinik belirtilerini, fenotiplerini ve sonuçlarını araştırmayı amaçladık. Acil servise akut kalp yetmezliği belirti ve bulguları ile başvuran hastalar çalışmaya dahil edildi. Erken (30 dakika ve altı) ve gecikmeli (30 dakika üzeri) tedavi gruplarının klinik özellikleri diüretik ve nitrat tedavisinin süresine göre değerlendirildi. 719 hastanın medyan yaşı 73 idi [66-80 IQR] ve 395'i (%54.9) erkekti. 682 (%94,9) hastaya furosemid tedavisi, 537 (%74,7) hastaya gliserol trinitrat tedavisi verildi. Hem furosemid hem de nitratın erken tedavisini alan hastalarda hastane içi ölüm oranları yüksekti (OR: 5.802, %95 GA: 1.885-17.831, p = 0.001 ve OR: 5.229, %95 GA: 1.355–20.115, p = 0.013 , sırasıyla). Erken furosemid tedavisi alan hastalarda 3 aylık mortalite oranları da yüksekti (OR: 1.864, %95 GA: 1.078–3.223, p = 0.026). Erken dönemde (<30 dk) diüretik ve nitrat başlanan hastaların acil serviste kalış süreleri daha kısaydı. Hastane içi mortalite erken tedavi grubunda daha yüksekti. 

Keywords

kalp yetersizliği, furosemid, nitratlar, acil servis

References

• McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Aug 27;ehab368.
• Matsue Y, Damman K, Voors AA, Kagiyama N, Yamaguchi T, Kuroda S, et al. Time-to-Furosemide Treatment and Mortality in Patients Hospitalized With Acute Heart Failure. Journal of the American College of Cardiology. 2017 Jun 27;69(25):3042–51.
• Mebazaa A, Yilmaz MB, Levy P, Ponikowski P, Peacock WF, Laribi S, et al. Recommendations on pre-hospital and early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine – short version. Eur Heart J. 2015 Aug 7;36(30):1958–66.
• Harjola P, Harjola V-P. [Can we do more for patients with acute heart failure before arrival at the hospital?]. Emergencias. 2017 Jul;29(4):221–2.
• Arrigo M, Jessup M, Mullens W, Reza N, Shah AM, Sliwa K, et al. Acute heart failure. Nat Rev Dis Primers. 2020 Mar 5;6(1):16.
• Mullens W, Damman K, Harjola V-P, Mebazaa A, Brunner-La Rocca H-P, Martens P, et al. The use of diuretics in heart failure with congestion - a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2019 Feb;21(2):137–55.
• Martens P, Nijst P, Mullens W. Current Approach to Decongestive Therapy in Acute Heart Failure. Curr Heart Fail Rep. 2015 Dec 1;12(6):367–78.
• Piper S, McDonagh T. The Role of Intravenous Vasodilators in Acute Heart Failure Management. European Journal of Heart Failure. 2014;16(8):827–34.
• Iqbal AM, Mohammed SK, Zubair N, Mubarik A, Ahmed A, Jamal SF, et al. The Impact of Door to Diuretic Time in Acute Heart Failure on Hospital Length of Stay and In-Patient Mortality. Cureus. 2021 Jan 16;13(1):e12742.
• Park Jin Joo, Kim Sun-Hwa, Oh Il-Young, Choi Dong-Ju, Park Hyun-Ah, Cho Hyun-Jai, et al. The Effect of Door-to-Diuretic Time on Clinical Outcomes in Patients With Acute Heart Failure. JACC: Heart Failure. 2018 Apr 1;6(4):286–94.
• Wakai A, McCabe A, Kidney R, Brooks SC, Seupaul RA, Diercks DB, et al. Nitrates for acute heart failure syndromes. Cochrane Database Syst Rev. 2013 Aug 6;(8):CD005151.
• Shoaib A, Farag M. Nitrates for the Management of Acute Heart Failure Syndromes. Emerg Med. 2016;06(03). Available from: http://www.omicsgroup.org/journals/nitrates-for-the-management-of-acute-heart-failure-syndromes-2165-7548-1000320.php?aid=73745
• Collins S, Martindale J. Optimizing Hypertensive Acute Heart Failure Management with Afterload Reduction. Curr Hypertens Rep. 2018 Feb 24;20(1):9.
• Takeuchi M, Nagai M, Dote K, Kato M, Oda N, Kunita E, et al. Early drop in systolic blood pressure, heart rate at admission, and their effects on worsening renal function in elderly patients with acute heart failure. BMC Cardiovascular Disorders. 2020 Aug 10;20(1):366.
• Vollmert T, Hellmich M, Gassanov N, Er F, Yücel S, Erdmann E, et al. Heart rate at discharge in patients with acute decompensated heart failure is a predictor of mortality. European Journal of Medical Research. 2020 Oct 8;25(1):47.
• Moreno-González R, Formiga F, Mora Lujan JM, Chivite D, Ariza-Solé A, Corbella X. Usefulness of systolic blood pressure combined with heart rate measured on admission to identify 1-year all-cause mortality risk in elderly patients firstly hospitalized due to acute heart failure. Aging Clin Exp Res. 2020 Jan;32(1):99–106.