Τίτλος:
Loop Diuretic Prescription and Long-Term Outcomes in Heart Failure: Association Modification by Congestion
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background: The effect of loop diuretics on clinical outcomes in heart failure has not been evaluated in randomized controlled trials. In hospitalized patients with heart failure, a discharge loop diuretic prescription has been shown to be associated with improved 30-day outcomes, which appears to be more pronounced in subgroups with congestion. In the current study, we examined these associations and association modifications during longer follow-up. Methods: We assembled a propensity score-matched cohort of 2191 pairs of hospitalized heart failure patients discharged with, vs without, a prescription for loop diuretics, balanced on 74 baseline characteristics (mean age 78 years; 54% women; 11% African American). Results: Hazard ratio (HR) and 95% confidence interval (CI) for 6-year combined endpoint of heart failure readmission or all-cause mortality was 1.02 (0.96-1.09). HRs and 95% CIs for this combined endpoint in patients with no, mild-to-moderate, and severe pulmonary rales were 1.19 (1.07-1.33), 0.95 (0.86-1.04), and 0.77 (0.63-0.94), respectively (P for interaction, <.001). Respective HRs (95% CIs) for no, mild-to-moderate, and severe lower extremity edema were 1.16 (1.06-1.28), 0.94 (0.85-1.04), and 0.71 (0.56-0.89; interaction P <.001). Conclusions: The association between a discharge loop diuretic prescription and long-term clinical outcomes in hospitalized patients with heart failure is modified by admission congestion with worse, neutral, and better outcomes in patients with no, mild-to-moderate, and severe congestion, respectively. If these findings can be replicated, congestion may be used to risk-stratify patients with heart failure for potential optimization of loop diuretic prescription and outcomes. © 2020
Συγγραφείς:
Faselis, C.
Lam, P.H.
Patel, S.
Arundel, C.
Filippatos, G.
Deedwania, P.
Zile, M.R.
Wopperer, S.
Nguyen, T.
Allman, R.M.
Fonarow, G.C.
Ahmed, A.
Περιοδικό:
AMERICAN JOURNAL OF MEDICINE
Εκδότης:
HANLEY & BELFUS-ELSEVIER INC
Λέξεις-κλειδιά:
aldosterone antagonist; angiotensin receptor antagonist; beta adrenergic receptor blocking agent; digoxin; dipeptidyl carboxypeptidase inhibitor; loop diuretic agent; loop diuretic agent, African American; age distribution; aged; all cause mortality; Article; clinical feature; cohort analysis; congestive heart failure; controlled study; crackle; disease severity; drug efficacy; female; follow up; heart failure; hospital discharge; hospital readmission; human; leg edema; long term outcome; major clinical study; male; observational study; outcome assessment; prescription; propensity score; risk assessment; sex difference; treatment outcome; complication; heart failure; hospitalization; mortality; procedures; proportional hazards model; time; very elderly, Aged; Aged, 80 and over; Cohort Studies; Female; Heart Failure; Hospitalization; Humans; Male; Mortality; Outcome Assessment, Health Care; Propensity Score; Proportional Hazards Models; Sodium Potassium Chloride Symporter Inhibitors; Time
DOI:
10.1016/j.amjmed.2020.11.019
