Captopril versus hydralazine-isosorbide dinitrate vasodilator protocols in acute decompensated heart failure patients transitioning from sodium nitroprusside

Link to article at PubMed

J Card Fail. 2021 May 26:S1071-9164(21)00197-4. doi: 10.1016/j.cardfail.2021.05.007. Online ahead of print.


INTRODUCTION: The role of oral vasodilators in the management of acute decompensated heart failure (ADHF) is not clearly defined. We evaluated the use of captopril vs. hydralazine-isosorbide dinitrate (H-ISDN) in the transition from sodium nitroprussside (SNP) in ADHF patients.

METHODS AND RESULTS: A retrospective chart review of 369 consecutive adult ICU patients with ADHF and reduced ejection fraction who received either a captopril or H-ISDN protocol to transition from SNP was performed. Captopril patients were matched 1:2 to H-ISDN patients, based on serum creatinine (SCr) andrace (black vs non-black). Baseline demographics, serum chemistry, and use of ACE-I/ARB were similar between groups. Time to SNP discontinuation (46.9 vs 40.4 hours, p=0.11) and hospital LOS (9.86 vs 7.99 days, p=0.064) were similar between groups. ICU LOS was statistically shorter in the H-ISDN group (4.11 vs 3.96 days, p=0.038). Fewer H-ISDN patients were discharged on an ACEi/ARB (82.9 % vs 69.9%, p=0.003) despite similar kidney function at time of discharge (SCr 1.1 vs 1.2, p=0.113). No difference was observed in rates of readmission (40.7% vs 50%, p=0.09) or mortality (16.3% vs 17.5 %, p=0.77) at one year post discharge.

CONCLUSION: Similar in-patient and one-year outcomes were observed between patients using H-ISDN versus ACEi when transitioning from SNP, even though fewer H-ISDN patients were discharged on ACEi/ ARB despite similar kidney function.

PMID:34051349 | DOI:10.1016/j.cardfail.2021.05.007

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