Abstract: Introduction and objectives: There is little evidence on the prognostic influence of intravenous nitrates in
patients with acute heart failure. Our purpose was to determine the influence of this treatment on early
mortality and new visits.
Methods: Prospective, multicenter cohort study of patients with acute heart failure in an emergency
room during 2 periods (May 2009 and November-December 2011). Patients with systolic blood
pressure > 110 mmHgwere included,groupedaccording towhether theyreceivedintravenousnitroglycerin
or not. Endpoints were mortality at 3, 7, 14, and 30 days and new visits at 30 days. The propensity score
was estimated by logistic regression to determine the prognostic influence of the treatment.
Results: We included 3178 of 4897 individuals. A total of 308 (9.7%) had died within 30 days and 465
(17%) attended new visits. The mean (standard deviation) age was 79.5 (10.0) years, and 796 (25%)
patients received intravenous nitrates. After matching, there were 685 individuals in each group. The
hazard ratio for 30-day mortality with nitrates was 1.21 (95% confidence interval, 0.87-1.70) and was
0.93 for new visits (95% confidence interval, 0.71-1.22). The results were similar for mortality at 3, 7, and
14 days (hazard ratio = 1.05 [95% confidence interval, 0.56-1.96], hazard ratio = 1.20 [95% confidence
interval, 0.74-1.94], and hazard ratio = 1.23 [95% confidence interval, 0.82-1.84], respectively). In the
presence of hypertensive pulmonary edema, the nitrates group showed a hazard ratio of 0.88 (95%
confidence interval, 0.47-1.63) for 30-day mortality.
Conclusions: Intravenous nitrates do not influence early mortality or new visits in patients with acute
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