Τίτλος:
Loop Diuretic Prescription and 30-Day Outcomes in Older Patients With Heart Failure
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background: Heart failure (HF) is a major source of morbidity and mortality. Fluid retention and shortness of breath are its cardinal manifestations for which loop diuretics are used. Although their usefulness is well accepted, less is known about their role in improving clinical outcomes. Objectives: The purpose of this study was to determine the relationship between loop diuretics and clinical outcomes in patients with HF. Methods: Of the 25,345 older patients hospitalized for HF in the Medicare-linked OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) registry, 9,866 (39%) received no pre-admission diuretics. The study excluded 1,083 patients receiving dialysis and 847 discharged on thiazide diuretics. Of the remaining 7,936 patients, 5,568 (70%) were prescribed loop diuretics at discharge. Using propensity scores for receipt of loop diuretics estimated for each of the 7,936 patients, a matched cohort of 2,191 pairs of patients was assembled balanced on 74 baseline characteristics. Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes were estimated in the matched cohort. Results: Matched patients (n = 4,382) had a mean age of 78 years, 54% were women, and 11% were African American. The 30-day all-cause mortality occurred in 4.9% (107 of 2,191) and 6.6% (144 of 2,191) of patients in the loop diuretic and no loop diuretic groups, respectively (HR when the use of loop diuretics was compared with nonuse: 0.73; 95% CI: 0.57 to 0.94; p = 0.016). Patients in the loop diuretic group had a significantly lower risk of 30-day HF readmission (HR: 0.79; 95% CI: 0.63 to 0.99; p = 0.037) but not of 30-day all-cause readmission (HR: 0.89; 95% CI: 0.79 to 1.01; p = 0.081). None of the associations was statistically significant during 60 days of follow-up. Conclusions: Hospitalized older patients not taking diuretics prior to hospitalization for HF decompensation who received a discharge prescription for loop diuretics had significantly better 30-day clinical outcomes than those not discharged on loop diuretics. These findings provide new information about short-term clinical benefits associated with loop diuretic use in HF. © 2020
Συγγραφείς:
Faselis, C.
Arundel, C.
Patel, S.
Lam, P.H.
Gottlieb, S.S.
Zile, M.R.
Deedwania, P.
Filippatos, G.
Sheriff, H.M.
Zeng, Q.
Morgan, C.J.
Wopperer, S.
Nguyen, T.
Allman, R.M.
Fonarow, G.C.
Ahmed, A.
Περιοδικό:
Journal of the American College of Cardiology
Εκδότης:
ELSEVIER SCIENCE INC 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA
Λέξεις-κλειδιά:
acetylsalicylic acid; aldosterone antagonist; amlodipine; angiotensin receptor antagonist; antiarrhythmic agent; beta adrenergic receptor blocking agent; digoxin; dipeptidyl carboxypeptidase inhibitor; loop diuretic agent; thiazide diuretic agent; warfarin; loop diuretic agent, African American; age distribution; aged; all cause mortality; Article; cardiovascular risk; controlled study; descriptive research; disease registry; female; follow up; geriatric patient; heart failure with preserved ejection fraction; heart failure with reduced ejection fraction; hospital discharge; hospital readmission; human; length of stay; major clinical study; male; outcome assessment; prescription; priority journal; risk assessment; risk benefit analysis; sex difference; treatment outcome; cohort analysis; heart failure; time factor; treatment outcome; very elderly, Aged; Aged, 80 and over; Cohort Studies; Female; Heart Failure; Humans; Male; Sodium Potassium Chloride Symporter Inhibitors; Time Factors; Treatment Outcome
DOI:
10.1016/j.jacc.2020.06.022
