2026-04-29T23:04:15Zhttps://repisalud.isciii.es/rest/oai/request

oai:repisalud.isciii.es:20.500.12105/231922024-11-28T17:31:34Zcom_20.500.12105_15322com_20.500.12105_2051col_20.500.12105_16961col_20.500.12105_16967col_20.500.12105_16969

00925njm 22002777a 4500 dc Miro, Oscar author Llorens, Pere author Freund, Yonathan author Davison, Beth author Takagi, Koji author Herrero-Puente, Pablo author Jacob, Javier author Martin-Sanchez, Francisco Javier author Gil, Victor author Rosselló, Xavier author Alquezar-Arbe, Aitor author Jimenez-Fabrega, Francesc X author Masip, Josep author Mebazaa, Alexandre author Cotter, Gad author EAHFE Res Group author 2021-12-01 Background and objective: Although recommended for the treatment of acute heart failure (AHF), the use of intravenous (IV) nitroglycerin (NTG) is supported by scarce and contradicting evidence. In the current analysis, we have assessed the impact of IV NTG administration by EMS or in emergency department (ED) on outcomes of AHF patients. Methods: We analyze AHF patients included by 45 hospitals that were delivered to ED by EMS. Patients were grouped according to whether treatment with IV NTG was started by EMS before ED admission (preED-NTG), during the ED stay (ED-NTG) or were untreated with IV NTG (no-NTG, control group). In-hospital, 30-day and 365-day all-cause mortality, prolonged hospitalization (>7 days) and 90-day post-discharge combined adverse events (ED revisit, hospitalization or death) were compared in EMS-NTG and ED-NTG respect to control group. Results: We included 8424 patients: preED-NTG = 292 (3.5%), ED-NTG = 1159 (13.8%) and no-NTG = 6973 (82.7%). preED-NTG group had the most severely decompensated cases of AHF (p < 0.001) but it had lower inhospital (OR = 0.724, 95%CI = 0.459-1.114), 30-day (HR = 0.818, 0.576-1.163) and 365-day mortality (HR = 0.692, 0.551-0.869) and 90-day post-discharge events (HR = 0.795, 0.643-0.984) than control group. ED-NTG group had mortalities similar to control group (in-hospital: OR = 1.164, 0.936-1.448; 30-day: HR = 0.980, 0.819-1.174; 365-day: HR = 0.929, 0.830-1.039) but significantly decreased 90-day post-discharge events (HR = 0.870, 0.780-0.970). Prolonged hospitalization rate did not differ among groups. Five different analyses confirmed these findings. Conclusions: Early prehospital IV NTG administration was associated with lower mortality and post-discharge events, while IV NTG initiated in ED only improved post-discharge event rate. Further studies are needed to assess the role of early prehospital administration of IV NTG to patients with AHF. Miro O, Llorens P, Freund Y, Davison B, Takagi K, Herrero-Puente P, et al. Early intravenous nitroglycerin use in prehospital setting and in the emergency department to treat patients with acute heart failure: Insights from the EAHFE Spanish registry. Int J Cardiol. 2021 Dec 1;344:127-34. 10.1016/j.ijcard.2021.09.031 1874-1754 0167-5273 International Journal of Cardiology https://hdl.handle.net/20.500.13003/19550 34543690 L2014723315 2-s2.0-85115644341 https://hdl.handle.net/20.500.12105/23192 757375800024 Acute heart failure Nitrates Nitroglycerine Outcome Mortality Early intravenous nitroglycerin use in prehospital setting and in the emergency department to treat patients with acute heart failure: Insights from the EAHFE Spanish registry