Captopril Versus Hydralazine-Isosorbide Dinitrate Vasodilator Protocols in Patients With Acute Decompensated Heart Failure Transitioning From Sodium Nitroprusside
Graphical Abstract
Section snippets
Study Population
A single-center, retrospective chart review of consecutive adult patients (≥18 years of age) with New York Heart Association class III--IV symptoms who were admitted to the HFICU with ADHF requiring intravenous vasodilator therapy between the periods of July 1, 2010, and July 31, 2016, was completed. Patients were included if they had a left ventricular (LV) ejection fraction of ≤40% and were initiated on predefined captopril or H-ISDN protocols (Table 1) following hemodynamic stabilization
Results
Of a total of 783 patients screened, 369 patients met the inclusion criteria and were able to be matched (Fig. 1, STROBE diagram). These patients were matched 1:2 based on race (Black vs non-Black) and SCr categories on the day of protocol initiation (SCr <1.5, 1.5–2.4, ≥2.5). SCr was statistically significantly higher at 3 time points (admission, protocol initiation and SNP discontinuation) in the H-ISDN vs the captopril group. While the resultant SCr distribution between the matched groups
Discussion
This study has 3 significant findings regarding vasodilator weaning in patients with low cardiac output. First, there was no difference in time to wean from SNP, hospital length of stay, or mortality or hospitalization at 1 year postdischarge between using either a captopril or an H-ISDN vasodilator protocol in an ICU setting. Second, more patients who were treated with the captopril protocol in the ICU were discharged on ACEi/ARB therapy compared to those who received the H-ISDN protocol
Conclusion
Administration of ACEi or H-ISDN to patients in the ICU with low cardiac output resulted in a similar time required to wean from SNP and no difference in readmission or mortality at 1 year postdischarge based on the vasodilator group selected. Patients who were prescribed H-ISDN were less likely to receive ACEis/ARBs at discharge despite similar discharge renal function between groups.
Disclosures
Dr. Tang is a consultant for Sequana Medical, Owkin, Relypsa, and PreCardiac, has received honoraria from Springer Nature for authorship/editorship and the American Board of Internal Medicine for exam writing committee participation, all unrelated to the subject and contents of this article. Dr. Perez is a consultant at Abiomed and is currently employed by Anthem. This manuscript does not represent the views or policies of Anthem. Dr. Perez was previously employed by Cleveland Clinic at the
References (11)
- et al.
Effect of direct vasodilation with hydralazine versus angiotensin-converting enzyme inhibition with captopril on mortality in advanced heart failure: The Hy-C Trial
J Am Coll Cardiol
(1992) - et al.
Clinical pharmacy services in heart failure: an opinion paper from the Heart Failure Society of America and American College of Clinical Pharmacy Cardiology Practice and Research Network
J Card Fail
(2013) - et al.
Impact of a comprehensive heart failure management program on hospital readmission and functional status of patients with advanced heart failure
J Am Coll Cardiol
(1997) - et al.
2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Circulation
(2013) - et al.
2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America
Circulation
(2017)
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