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Short-term survival by treatment among patients hospitalized with acute heart failure: the global ALARM-HF registry using propensity scoring methods

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Abstract

Purpose

To date, treatment with intravenous (IV) agents such as vasodilators, diuretics, and inotropes has shown marginal or mixed benefits in acute heart failure (AHF) trials. The aim of this study was to identify the risks and benefits of IV drugs in patients hospitalized with acute decompensated heart failure.

Methods

The AHF global survey of standard treatment (ALARM-HF) reviewed in-hospital treatments in eight countries. The present study was a post hoc analysis of ALARM-HF data in which propensity scoring was used to identify groups of patients who differed by treatment but had the same multivariate distribution of covariates. Such propensity matching allowed estimations of the effect of specific treatments on the outcome of in-hospital mortality.

Results

Unadjusted analysis showed a lower in-hospital mortality rate in AHF patients receiving “diuretics + vasodilators” (n = 1,805) compared to those receiving “diuretics alone” (n = 2,362) (7.6 vs. 14.2%, p < 0.0001). Propensity-based matching (n = 1,007 matched pairs) confirmed the lower mortality of AHF patients receiving diuretics + vasodilators: 7.8 versus 11.0% (p = 0.016). Unadjusted analysis showed a much greater in-hospital mortality rate in patients receiving IV inotropes (25.9%) compared to those who did not (5.2%) (p < 0.0001). Propensity-based matching (n = 954 pairs) confirmed that IV catecholamine use was associated with 1.5-fold increase for dopamine or dobutamine use and a >2.5-fold increase for norepinephrine or epinephrine use.

Conclusions

In terms of in-hospital survival, a vasodilator in combination with a diuretic fared better than treatment with only a diuretic. Catecholamine inotropes should be used cautiously as it has been seen that they actually increase the risk for in-hospital mortality.

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Abbreviations

AHF:

Acute heart failure

SBP:

Systolic blood pressure

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Conflict of interest

AM, JP, FVB, JFD and FF received an honorarium from Abbott for lectures and/or consulting. Abbott funded the ALARM-HF survey; data were acquired by IMS. Analyses were performed by the Département de Biostatistique et Informatique Médicale, Hôpital Saint-Louis, APHP, Université Paris 7, INSERM—UMR-S 717, Paris France by RP and EG.

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Authors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, Hôpital Lariboisère, L’Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France

    Alexandre Mebazaa & Etienne Gayat

  2. UMR-S 942 Inserm, Paris, France

    Alexandre Mebazaa

  3. Univ Paris Diderot, Paris, France

    Alexandre Mebazaa, Raphael Porcher & Etienne Gayat

  4. 2 Rue Ambroise Paré, 75475, Paris Cedex 10, France

    Alexandre Mebazaa

  5. Heart Failure Clinic and Second Cardiology Department, Attikon University Hospital, Athens, Greece

    John Parissis & Maria Nikolaou

  6. Département de Biostatistique et Informatique Médicale, Hôpital Saint-Louis, AP-HP, Paris, France

    Raphael Porcher

  7. UMR-S 717, Inserm, Paris, France

    Raphael Porcher & Etienne Gayat

  8. Cardiology Division and Heart Failure and Transplantation Program, Hospital Espanhol, Salvador, Bahia, Brazil

    Fabio Vilas Boas

  9. Heart Failure and Transplant Unit, Cardiology Department, Hospital Doce de Octubre, Madrid, Spain

    J. F. Delgado

  10. Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland

    Ferenc Follath

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  1. Alexandre Mebazaa
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  2. John Parissis
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  3. Raphael Porcher
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  6. Fabio Vilas Boas
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Correspondence to Alexandre Mebazaa.

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Mebazaa, A., Parissis, J., Porcher, R. et al. Short-term survival by treatment among patients hospitalized with acute heart failure: the global ALARM-HF registry using propensity scoring methods. Intensive Care Med 37, 290–301 (2011). https://doi.org/10.1007/s00134-010-2073-4

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  • DOI: https://doi.org/10.1007/s00134-010-2073-4

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