- In acute heart failure (acute HF), early intensive, sustained vasodilation yields no better outcomes for all-cause mortality or HF rehospitalization at 180 days vs usual care.
Why this matters
- Editorial: results add to others indicating that without hypertension, early intensive therapy offers little benefit vs using loop diuretics.
- 30.6% mortality with early intensive therapy vs 27.8% with usual care.
- All-cause mortality/HF rehospitalization composite: adjusted HR, 1.07 (95% CI, 0.83-1.39; P=.59).
- Common adverse events were hypokalemia (23% intervention, 25% usual care) and worsening renal function (21% intervention, 20% usual care), along with headache, dizziness, and hypotension (all more common with intervention).
- Secondary endpoints (e.g., all-cause death, median length of stay) also did not differ between intervention and usual care.
- Open-label randomized trial with 788 participants (randomly allocated 1:1), 10 hospitals in Europe and Brazil, enrolled December 2007 to last follow-up in February 2019.
- Primary endpoint: composite of all-cause mortality/HF rehospitalization at 180 days.
- Funding: Swiss National Science Foundation; others.
- Generalizability unclear with exclusion of patients with severe renal dysfunction, systolic BP