Abstract
There are nearly 700,000 annual US emergency department (ED) visits for acute heart
failure (AHF). Although blood pressure is elevated on most of these visits, acute
therapy remains focused on preload and not afterload reduction. Data from recent prospective
studies suggest that patients with AHF with concomitant acute hypertension benefit
from intravenous (IV) vasodilators. To better understand the use of vasodilators for
such patients, we conducted a systematic review of (1) currently available intravenous
vasodilators for ED patients with AHF, or (2) intravenous vasodilators that are not
yet available, but have completed phase III clinical trials in AHF, and may be available
for ED use in the future. We used multiterm search queries to retrieve research involving
nitroglycerin, nitroprusside, enalaprilat, hydralazine, relaxin, and nesiritide. A
total of 2001 unique citations were identified from 3 databases: PubMed, EMBASE, and
CINAHL. Of these, 1966 were excluded on the basis of established review criteria,
leaving 35 published articles for inclusion. Our primary finding was that intravenous
nitrovasodilators, when used in the treatment of AHF in ED and ED-like settings, do
improve short-term symptoms and appear safe to administer. There are no data suggesting
that they impact mortality. Other commonly used vasodilators such as hydralazine and
enalaprilat have very little published data about their safety and efficacy. Of note,
few studies enrolled patients early in their course of treatment. Thus, to assess
the specific impact of vasodilator therapy on both short- and long-term outcomes,
future research efforts should focus on patient recruitment in the ED setting.
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Article Info
Publication History
Published online: September 17, 2014
Accepted:
September 2,
2014
Received in revised form:
September 2,
2014
Received:
July 23,
2014
Footnotes
â?†PA, JC, and LA: No conflict of Interest.
��PP: Consultant for Janssen, Medtronic, Novartis, Otsuka, Trevena, SpringLeafTx, BG Medicine. Research support: Abbott, Alere.
â?…SC: Research support: NIH/NHLBI, Medtronic, Cardiorentis, Abbott Point-of-Care, Novartis, The Medicines Company, Radiometer. Consulting: Trevena, Novartis, Otsuka, Radiometer, The Medicines Company, Medtronic, Astellas.
â?…â?…AS: Current grant support: Abbott Diagnostics , NIH/NHLBI ( K23HL085387 ), NIH/NHLBI ( K12HL1090 ), National Center for Advancing Translational Sciences ( UL1TR000445 ), Centers for Disease Control, Roche Diagnostics . Current consultant: Roche Diagnostics, Novartis Pharmaceuticals Corp, USA.
���PL: Consultant: The Medicines Company (Data Safety Monitoring Board), Corthera, Inc, Bayer Schering, Pharma AG, EKR Therapeutics, Trevena, Inc. Research support/grants: The Cleveland Clinic Foundation , Nile Therapeutics, Corthera, Inc , Bayer Schering Pharma AG . Speakers bureau: The Society of Chest Pain Centers.
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© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
