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General Critical Care

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Vasodilators for Acute Heart Failure — A Systematic Review with Meta-Analysis | NEJM Evidence

This systematic review and meta-analysis evaluated the effects of vasodilators in acute heart failure through 46 RCTs involving 28,374 patients. Vasodilators did not significantly reduce all-cause mortality (RR, 0.95; 95% CI, 0.87-1.04; P=0.26). There was no significant difference in serious adverse events (RR, 1.01; 95% CI, 0.97-1.05) or length of hospital stay (mean difference, –0.10 days; 95% CI, –0.28 to 0.08).


However, vasodilators were associated with a lower risk of tracheal intubation (RR, 0.54; 95% CI, 0.30-0.99).



Vasodilators for Acute Heart Failure — A Systematic Review with Meta-Analysis | NEJM Evidence

This comprehensive synthesis revealed no statistical difference in primary outcomes between vasodilator and control groups. The heterogeneity in patient populations and variability in LV ejection fraction likely influenced results. Future research should target specific phenotypes, considering parameters like systolic BP, mitral regurgitation, and concomitant therapies, to identify subgroups that may benefit from vasodilators. I think patient with conditions that increase arterial elastance would still benefit from vasodilator therapy.

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