Intensive Care Medicine

, Volume 37, Issue 2, pp 290–301 | Cite as

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

  • Alexandre Mebazaa
  • John Parissis
  • Raphael Porcher
  • Etienne Gayat
  • Maria Nikolaou
  • Fabio Vilas Boas
  • J. F. Delgado
  • Ferenc Follath
Original

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.

Keywords

Acute heart failure ALARM-HF data Intravenous agents In-hospital survival 

Abbreviations

AHF

Acute heart failure

SBP

Systolic blood pressure

Supplementary material

134_2010_2073_MOESM1_ESM.doc (218 kb)
Supplementary material (DOC 218 kb)

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Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Alexandre Mebazaa
    • 1
    • 2
    • 3
    • 4
  • John Parissis
    • 5
  • Raphael Porcher
    • 3
    • 6
    • 7
  • Etienne Gayat
    • 1
    • 3
    • 7
  • Maria Nikolaou
    • 5
  • Fabio Vilas Boas
    • 8
  • J. F. Delgado
    • 9
  • Ferenc Follath
    • 10
  1. 1.Department of Anesthesiology and Critical Care Medicine, Hôpital LariboisèreL’Assistance Publique-Hôpitaux de Paris (AP-HP)ParisFrance
  2. 2.UMR-S 942 InsermParisFrance
  3. 3.Univ Paris DiderotParisFrance
  4. 4.Paris Cedex 10France
  5. 5.Heart Failure Clinic and Second Cardiology DepartmentAttikon University HospitalAthensGreece
  6. 6.Département de Biostatistique et Informatique Médicale, Hôpital Saint-Louis, AP-HPParisFrance
  7. 7.UMR-S 717, InsermParisFrance
  8. 8.Cardiology Division and Heart Failure and Transplantation ProgramHospital EspanholSalvadorBrazil
  9. 9.Heart Failure and Transplant Unit, Cardiology DepartmentHospital Doce de OctubreMadridSpain
  10. 10.Department of Internal MedicineUniversity Hospital ZurichZurichSwitzerland

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