SAN FRANCISCO — Giving high-dose nitroglycerin to patients with heart failure who come to the emergency department between midnight and 8 a.m. may shorten their length of stay by nearly a day, John R. Allegra, M.D., said in a poster at the annual meeting of the American College of Emergency Physicians.
Nineteen patients treated by physicians who use high-dose nitroglycerin went home after a mean of 3.7 days in the hospital, compared with 4.6 mean days of hospitalization for 105 patients seen by emergency physicians who don't use high-dose nitroglycerin, said Dr. Allegra of Morristown (N.J.) Memorial Hospital. The difference of 0.9 days was statistically significant.
The retrospective analysis used data from a previous study which showed that patients arriving in the emergency department (ED) between midnight and 8 a.m. were more likely than patients arriving at other times to benefit from aggressive nitroglycerin therapy in the ED.
The investigators chose to study that time period because patients seen in the ED between midnight and 8 a.m. had the highest rates of intubation and mechanical ventilation, Dr. Allegra said in an interview. “If we were to see any effects of the nitroglycerin, it would be in those patients,” he explained.
The current analysis included patients seen in the ED during those hours over a 20-month period who were admitted for heart failure. To lessen the influence of statistical outliers on the results, the analysis excluded patients who spent more than 10 days in the hospital.
A prior survey on the treatment of heart failure in the hospital's ED asked physicians if they use nitroglycerin boluses to treat heart failure. Based on responses to that survey, investigators assigned patients in the current study to nitroglycerin or no-nitroglycerin groups depending on the treating ED physician.
Several previous studies have shown that high-dose nitroglycerin treatment decreased the incidence of death, myocardial infarction, and the use of mechanical ventilation in patients with heart failure.
The current data show that patients who arrive in the ED during the first 8 hours of the day spend almost 1 less day in the hospital if they receive nitroglycerine boluses in the ED, compared with patients who don't get nitroglycerin, Dr. Allegra said.