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Early vasodilation in acute HF does not improve outcomes

ESC 2019

Results from the GALACTIC trial showed that early intensive vasodilation does not improve 180-day all-cause mortality and rehospitalisation in patients hospitalised for acute heart failure (HF), despite the use of individualised doses of various agents.

The GALACTIC trial hypothesised that early goal-directed therapy with maximal and persistent vasodilation would be able to achieve better clinical outcomes than standard care given to patients who were hospitalised for acute HF. A total of 781 patients were randomised to early goal-directed therapy or standard care until the moment of discharge. Early goal-directed therapy combined high and personalised doses of vasodilators including sublingual and transdermal nitrates, oral hydralazine for 48 hours to avoid tolerance to nitrates, and rapid up-titration of angiotensin-converting-enzyme inhibitors or angiotensin II receptor blockers. All other therapies including loop diuretic dose and duration, beta-blocke...

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