Current practices and perspectives on the use of intravenous vasodilators in acute heart failure: an international survey

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Abstract Aims Despite a strong pathophysiological rationale for the use of intravenous vasodilators (IVV) in acute heart failure (AHF), previous studies have yielded controversial results and international guidelines provide weak recommendations. This survey aimed to gather real-world data and physician perspectives on the management of IVV in AHF. Methods and results An online survey was designed and distributed to assess the use of IVV in AHF. A total of 170 cardiologists experienced in AHF care from 32 countries participated (67% male, mostly aged 30-50 years) with the majority (62%) reporting using IVV in fewer than 10 patients per month, and nitroglycerin being the preferred agent for 48% of respondents, followed by sodium nitroprusside (29%). Nearly half (48%) administer IVV also out of the intensive care setting, and 58% consider serial non-invasive blood pressure monitoring adequate. The main indications for IVV are acute decompensated heart failure (88%) while right ventricular failure (24%) cardiogenic shock (25%) and advanced decompensated heart failure (42%) are also potential indications. The main contraindication (51%) is low blood pressure, although the reported thresholds for blood pressure vary widely. IVV are used more frequently in heart failure with reduced (55%) rather than preserved (17%) ejection fraction. Huge differences exist among the cardiologists regarding the maintenance or withdrawal of oral neurohormonal drugs during the IVV infusion. Conclusions This survey shows that IVV are adopted in a limited number of AHF patients with considerable variability in practice patterns. Further well-designed studies focusing on patients’ characteristics associated with potential favourable response are needed.

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