Peacock William Frank, Emerman Charles, Costanzo Maria R, Diercks Deborah B, Lopatin Margarita, Fonarow Gregg C
Department of Emergency Medicine, The Cleveland Clinic, Cleveland, OH 44195, USA.
Congest Heart Fail. 2009 Nov-Dec;15(6):256-64. doi: 10.1111/j.1751-7133.2009.00112.x.
Vasoactive therapy is often used to treat acute decompensated heart failure (ADHF). The authors sought to determine whether clinical outcomes are temporally associated with time to vasoactive therapy (vasoactive time) in ADHF. Using the Acute Decompensated Heart Failure (ADHERE) Registry, the authors examined the relationship between vasoactive time and inpatient mortality within 48 hours of hospitalization. Vasoactive agents were used early (defined as <6 hours) in 22,788 (63.8%) patients and late in 12,912 (36.2%). Median vasoactive time was 1.7 and 14.7 hours in the early and late groups, respectively. In-hospital mortality was significantly lower in the early group (odds ratio, 0.87; 95% confidence interval, 0.79-0.96; P=.006), and the adjusted odds of death increased 6.8% for every 6 hours of treatment delay (95% confidence interval, 4.2-9.6; P<.0001). Early vasoactive initiation is associated with improved outcomes in patients hospitalized for ADHF.
血管活性药物治疗常用于治疗急性失代偿性心力衰竭（ADHF）。作者试图确定临床结局是否与ADHF患者开始血管活性药物治疗的时间（血管活性时间）存在时间关联。作者利用急性失代偿性心力衰竭（ADHERE）注册研究，考察了血管活性时间与住院48小时内住院死亡率之间的关系。22788例（63.8%）患者早期（定义为<6小时）使用血管活性药物，12912例（36.2%）患者晚期使用。早期组和晚期组的中位血管活性时间分别为1.7小时和14.7小时。早期组的住院死亡率显著较低（比值比，0.87；95%置信区间，0.79 - 0.96；P = 0.006），且每延迟治疗6小时，调整后的死亡几率增加6.8%（95%置信区间，4.2 - 9.6；P < 0.0001）。对于因ADHF住院的患者，早期启动血管活性药物治疗与改善结局相关。
