Clinical InvestigationCongestive Heart FailureUse and impact of inotropes and vasodilator therapy in hospitalized patients with severe heart failure
Section snippets
Methods
The design of the ESCAPE trial has been previously described.8 Briefly, ESCAPE was a multicenter randomized evaluation of 433 patients hospitalized with severe decompensated HF at 26 academic medical centers in the United States and Canada. Additional inclusion criteria were age >18 years; documented history of HF for ≥3 months; treatment with angiotensin-converting enzyme (ACE) inhibitors and diuretics for ≥3 months; documented left ventricular ejection fraction (LVEF) of <30% in the 12 months
Results
A total of 433 patients were enrolled in the ESCAPE trial. Of these, 215 were randomly assigned to the PAC group and 218 to the clinical assessment group. The mean time from hospital admission to randomization was 1.3 days. Table I summarizes the demographic and clinical characteristics of these patients. Patients had a mean age of 56 years, 74% were male, 60% were white, and 50% had an ischemic etiology for their HF. All patients had significant systolic dysfunction with a mean LVEF of 19.3%.
Discussion
This analysis provided information on the relative use of vasoactive medications and the factors determining their selection by clinicians for the treatment of patients with severe decompensated HF. Renal function and right atrial pressure were significant predictors for use of inotropes, whereas renal function and PCWP predicted the use of vasodilators. These data suggest that impairments of renal function and more severe hemodynamic abnormalities seem to influence the use of vasoactive
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This study was supported by the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD.