International Journal of Clinical Pharmacy

, Volume 39, Issue 3, pp 536–541 | Cite as

The effect of intravenous isosorbide dinitrate in acute decompensated heart failure in hospital

  • Jérémy Chambord
  • David Attivi
  • Véronique Thuus
  • Claire Zeghmouli
  • Stéphane GibaudEmail author
Research Article


Background According to new recommendations for the management of acute decompensated heart failure (ADHF) in 2015, intravenous vasodilator therapy might be given as an early therapy when systolic blood pressure is normal to high (≥110 mmHg). Only 29% of patients with ADHF are treated with vasodilators without medical contraindication. Objective To evaluate the effect of the systematic use of ISDN on ADHF without contraindication especially on rehospitalization rate. Settings The 600-bed hospital (Centre Hospitalier de l’Ouest Vosgien, Neufchâteau, France). Methods This is a retrospective study with data analysed from medical records. Patients with ADHF episodes and hospitalization in the cardiology department or intensive care unit (ICU) between November 2013 and December 2015 were included resulting in 199 hospitalizations in the analysis (37 were treated by ISDN, and 162 were not). Main outcome measure Effects of ISDN on 180-day hospital readmission for ADHF or acute myocardial infarction (AMI), in-hospital mortality, length of stay, number of ICU admissions, and ICU length of stay. Results Patients who received ISDN required more ICU admissions than the other patients (54.1 vs 33.3%, p = 0.02). Nevertheless 180-day hospital readmission was lower for patients who were receiving ISDN (8.1 vs 22.8%, p = 0.04). ISDN did not influence other clinical outcomes tested. Conclusion ISDN may minimize or prevent the consequences of altered haemodynamics. Lower rehospitalization rate with ISDN was seen in this study.


Acute decompensated heart failure France Guidelines Isosorbide dinitrate Rehospitalisation Vasodilator 



We thank all physicians who helped us in this study.



Conflicts of interest



  1. 1.
    Roger VL. Epidemiology of heart failure. Circ Res. 2013;113:646–59.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the task force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J. 2008;29:2388–442.CrossRefPubMedGoogle Scholar
  3. 3.
    Mebazaa A, Yilmaz MB, Levy P, Ponikowski P, Peacock WF, Laribi S, et al. Recommendations on pre-hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine. Eur J Heart Fail. 2015;17:544–58.CrossRefPubMedGoogle Scholar
  4. 4.
    Peacock WF, Emerman C, Costanzo MR, Diercks DB, Lopatin M, Fonarow GC. Early vasoactive drugs improve heart failure outcomes. Congest Heart Fail. 2009;15:256–64.CrossRefPubMedGoogle Scholar
  5. 5.
    Lemachatti N, Philippon AL, Bloom B, Hausfater P, Riou B, Ray P, et al. Temporal trends in nitrate utilization for acute heart failure in elderly emergency patients: a single-centre observational study. Arch Cardiovasc Dis. 2016;109:449–56.CrossRefPubMedGoogle Scholar
  6. 6.
    Ho EC, Parker JD, Austin PC, Tu JV, Wang X, Lee DS. Impact of nitrate use on survival in acute heart failure: a propensity-matched analysis. J Am Heart Assoc. 2016;. doi: 10.1161/JAHA.115.002531.Google Scholar
  7. 7.
    Beohar N, Erdogan AK, Lee DC, Sabbah HN, Kern MJ, Teerlink J, et al. Acute heart failure syndromes and coronary perfusion. J Am Coll Cardiol. 2008;52:13–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Gheorghiade M, Vaduganathan M, Fonarow GC, Bonow RO. Rehospitalization for heart failure: problems and perspectives. J Am Coll Cardiol. 2013;61:391–403.CrossRefPubMedGoogle Scholar
  9. 9.
    Schrier RW, Abraham WT. Hormones and hemodynamics in heart failure. N Engl J Med. 1999;341:577–85.CrossRefPubMedGoogle Scholar
  10. 10.
    Gheorghiade M, De Luca L, Fonarow GC, Filippatos G, Metra M, Francis GS. Pathophysiologic targets in the early phase of acute heart failure syndromes. Am J Cardiol. 2005;96:11G–7G.CrossRefPubMedGoogle Scholar
  11. 11.
    Horwich TB, Patel J, MacLellan WR, Fonarow GC. Cardiac troponin I is associated with impaired hemodynamics, progressive left ventricular dysfunction, and increased mortality rates in advanced heart failure. Circulation. 2003;108:833–8.CrossRefPubMedGoogle Scholar
  12. 12.
    McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2012;14:803–69.CrossRefPubMedGoogle Scholar
  13. 13.
    Abrams J. Beneficial actions of nitrates in cardiovascular disease. Am J Cardiol. 1996;77:31C–7C.CrossRefPubMedGoogle Scholar
  14. 14.
    Risordan 10 mg/10 ml injectable. In: Le Dictionnaire Vidal. Paris (France): Editions Vidal, 2016. p. 2369–2370.Google Scholar
  15. 15.
    Butler J, Forman DE, Abraham WT, Gottlieb SS, Loh E, Massie BM, et al. Relationship between heart failure treatment and development of worsening renal function among hospitalized patients. Am Heart J. 2004;147:331–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing 2017

Authors and Affiliations

  1. 1.Department of PharmacyCentre hospitalier de l’Ouest Vosgien (CHOV)NeufchâteauFrance
  2. 2.Department of CardiologyCentre hospitalier de l’Ouest Vosgien (CHOV)NeufchâteauFrance
  3. 3.EA3452/CITHEFOR, Faculté de pharmacieUniversité de LorraineNancyFrance
  4. 4.Pharmacie Clinique, Faculté de PharmacieUniversité de LorraineNancyFrance

Personalised recommendations