Evidence supporting the use of: Nitric Oxide
For the health condition: Congestive Heart Failure

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Synopsis

Source of validity: Scientific
Rating (out of 5): 3

Nitric oxide (NO) has a scientific basis for use in the management of certain aspects of congestive heart failure (CHF), though it is not a frontline therapy for chronic heart failure. Nitric oxide is a potent endogenous vasodilator, meaning it relaxes vascular smooth muscle, leading to dilation of blood vessels and reduced vascular resistance. In acute decompensated heart failure, particularly when complicated by elevated pulmonary pressures or right ventricular failure, inhaled nitric oxide can be used to selectively reduce pulmonary vascular resistance without causing systemic hypotension.

There is moderate-quality evidence (rated here as 3/5) supporting the use of inhaled nitric oxide in acute settings. Clinical trials and guidelines have described its utility in improving oxygenation and reducing right heart afterload in acute right ventricular failure or pulmonary hypertension, but it has not shown a mortality benefit in chronic heart failure or broad CHF populations. Its use is generally limited to intensive care settings or perioperative management in select cases. For chronic heart failure, strategies that enhance endogenous nitric oxide signaling (such as ACE inhibitors or nitrates) are more commonly used. Thus, while nitric oxide itself is used with scientific rationale in specific heart failure scenarios, its overall impact on long-term outcomes in CHF is limited.

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