• Alexandre Mebazaa, John Parissis, Raphael Porcher, Etienne Gayat, Maria Nikolaou, Fabio Vilas Boas, J F Delgado, and Ferenc Follath.
• Department of Anesthesiology and Critical Care Medicine, Hôpital Lariboisère, L'Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France. alexandre.mebazaa@lrb.aphp.fr
• Intensive Care Med. 2011 Feb 1; 37 (2): 290-301.

PurposeTo 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.MethodsThe 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.ResultsUnadjusted 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.ConclusionsIn 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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