Early sustained vasodilation yields little mortality benefit in acute HF

  • Kozhuharov N & al.
  • JAMA
  • 17 Dec 2019

  • International Clinical Digest
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Takeaway

  • In acute heart failure (acute HF), early intensive, sustained vasodilation yields no better outcomes for all-cause mortality or HF rehospitalization at 180 days vs usual care.

Why this matters

  • Editorial: results add to others indicating that without hypertension, early intensive therapy offers little benefit vs using loop diuretics.  

Key results

  • 30.6% mortality with early intensive therapy vs 27.8% with usual care.
  • All-cause mortality/HF rehospitalization composite: adjusted HR, 1.07 (95% CI, 0.83-1.39; P=.59).
  • Common adverse events were hypokalemia (23% intervention, 25% usual care) and worsening renal function (21% intervention, 20% usual care), along with headache, dizziness, and hypotension (all more common with intervention).
  • Secondary endpoints (e.g., all-cause death, median length of stay) also did not differ between intervention and usual care.

Study design

  • Open-label randomized trial with 788 participants (randomly allocated 1:1), 10 hospitals in Europe and Brazil, enrolled December 2007 to last follow-up in February 2019.
  • Primary endpoint: composite of all-cause mortality/HF rehospitalization at 180 days.
  • Funding: Swiss National Science Foundation; others.

Limitations

  • Generalizability unclear with exclusion of patients with severe renal dysfunction, systolic BP