Vasodilators for Acute Heart Failure - A Systematic Review with Meta-Analysis.

Autor:	Lukoschewitz JD; Department of Cardiology, Hvidovre Hospital, Copenhagen University Hospital, Copenhagen., Miger KC; Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen., Olesen ASO; Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen., Caidi NOE; Department of Cardiology, Hvidovre Hospital, Copenhagen University Hospital, Copenhagen., Jørgensen CK; Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen.; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark., Nielsen OW; Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen.; Department of Clinical Medicine, University of Copenhagen, Copenhagen., Hassager C; Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen.; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen., Hove JD; Department of Cardiology, Hvidovre Hospital, Copenhagen University Hospital, Copenhagen.; Department of Clinical Medicine, University of Copenhagen, Copenhagen., Seven E; Department of Cardiology, Hvidovre Hospital, Copenhagen University Hospital, Copenhagen., Møller JE; Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen.; Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark.; Department of Cardiology, University of Southern Denmark, Odense, Denmark., Jakobsen JC; Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen.; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark., Grand J; Department of Cardiology, Hvidovre Hospital, Copenhagen University Hospital, Copenhagen.
Jazyk:	angličtina
Zdroj:	NEJM evidence [NEJM Evid] 2024 Jun; Vol. 3 (6), pp. EVIDoa2300335. Date of Electronic Publication: 2024 May 28.
DOI:	10.1056/EVIDoa2300335
Abstrakt:	Background: Acute heart failure is a public health concern. This study systematically reviewed randomized clinical trials (RCTs) to evaluate vasodilators in acute heart failure. Methods: The search was conducted across the databases of Medline, Embase, Latin American and the Caribbean Literature on Health Sciences, Web of Science, and the Cochrane Central Register of Controlled Trials. Inclusion criteria consisted of RCTs that compared vasodilators versus standard care, placebo, or cointerventions. The primary outcome was all-cause mortality; secondary outcomes were serious adverse events (SAEs), tracheal intubation, and length of hospital stay. Risk of bias was assessed in all trials. Results: The study included 46 RCTs that enrolled 28,374 patients with acute heart failure. Vasodilators did not reduce the risk of all-cause mortality (risk ratio, 0.95; 95% confidence interval [CI], 0.87 to 1.04; I 2 =9.51%; P=0.26). No evidence of a difference was seen in the risk of SAEs (risk ratio, 1.01; 95% CI, 0.97 to 1.05; I 2 =0.94%) or length of hospital stay (mean difference, -0.10; 95% CI, -0.28 to 0.08; I 2 =69.84%). Vasodilator use was associated with a lower risk of tracheal intubation (risk ratio, 0.54; 95% CI, 0.30 to 0.99; I 2 =51.96%) compared with no receipt of vasodilators. Conclusions: In this systematic review with meta-analysis of patients with acute heart failure, vasodilators did not reduce all-cause mortality.
Databáze:	MEDLINE
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