Loop Diuretic Prescription and Long-Term Outcomes in Heart Failure: Association Modification by Congestion
| Autor: | Tran Nguyen, Phillip H. Lam, Gerasimos Filippatos, Samuel Wopperer, Ali Ahmed, Cherinne Arundel, Charles Faselis, Samir S. Patel, Gregg C. Fonarow, Prakash Deedwania, Richard M. Allman, Michael R. Zile |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty medicine.drug_class 030204 cardiovascular system & hematology Time law.invention Cohort Studies 03 medical and health sciences 0302 clinical medicine Sodium Potassium Chloride Symporter Inhibitors Randomized controlled trial law Internal medicine Outcome Assessment Health Care medicine Long term outcomes Humans 030212 general & internal medicine Mortality Medical prescription Propensity Score Aged Proportional Hazards Models Aged 80 and over Heart Failure business.industry Hazard ratio General Medicine Loop diuretic medicine.disease Confidence interval Hospitalization Heart failure Cohort Cardiology Female business |
| Zdroj: | The American Journal of Medicine. 134:797-804 |
| ISSN: | 0002-9343 |
| Popis: | 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.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).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).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. |
| Databáze: | OpenAIRE |
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