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

Öz

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.

Anahtar Kelimeler

• heart failure
• furosemide
• nitrates
• emergency department

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

Öz

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. 

Anahtar Kelimeler

• kalp yetersizliği
• furosemid
• nitratlar
• acil servis

Kaynakça

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