Parajuli Priyanka, Lara-Garcia Odalys Estefania, Regmi Manjari Rani, Skoza Warren, Bhattarai Mukul, Kulkarni Abhishek, Robinson Robert Leonard
Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL 62702, USA.
Division of Cardiology, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL 62702, USA.
Medicines (Basel). 2020 May 20;7(5):30. doi: 10.3390/medicines7050030.
The pharmacologic management of heart failure with preserved ejection fraction (HFpEF) involves far fewer options with demonstrated additional benefit. Therefore, we examined the effect of combination of multiple classes of HF medication in the 30-day hospital readmission in patients with HFpEF. All adult patients discharged with a diagnosis of HFpEF and a left ventricular ejection fraction (LVEF) of ≥ 50% reported during the admission or within the previous six months from our institution were retrospectively studied for a 30-day hospital readmission risk. Individual as well as combination drug therapy at the time of hospital discharge were evaluated using Pearson chi test and multivariate logistic regression. The overall 30-day readmission rate in this HFpEF cohort of 445 discharges was 29%. Therapy with loop diuretics ( = 0.011), loop diuretics and angiotensin receptor blocker ( = 0.043) and loop diuretics and beta blockers ( = 0.049) were associated with a lower risk of 30-day hospital readmission. Multivariate logistic regression revealed only loop diuretics to be associated with a lower risk of hospital readmission in patients with HFpEF (OR 0.59; 95% CI, 0.39-0.90; = 0.013). Our study revealed that loop diuretics at discharge decreases early readmission in patients with HFpEF. Further, our study highlights the implication of a lack of guidelines and treatment challenges in HFpEF patients and emphasizes the importance of a conservative approach in preventing early readmission in patients with HFpEF.
射血分数保留的心力衰竭（HFpEF）的药物治疗选择少得多，且鲜有已证实的额外获益。因此，我们研究了多种心力衰竭药物联合使用对HFpEF患者30天内再次入院的影响。对我院确诊为HFpEF且入院时或前六个月内报告的左心室射血分数（LVEF）≥50%的所有成年出院患者进行回顾性研究，评估其30天内再次入院的风险。采用Pearson卡方检验和多因素逻辑回归评估出院时的单一药物治疗及联合药物治疗情况。在这个由445例出院患者组成的HFpEF队列中，总体30天再入院率为29%。使用袢利尿剂治疗（P = 0.011）、袢利尿剂与血管紧张素受体阻滞剂联合治疗（P = 0.043）以及袢利尿剂与β受体阻滞剂联合治疗（P = 0.049）与30天再次入院风险较低相关。多因素逻辑回归显示，只有袢利尿剂与HFpEF患者再次入院风险较低相关（OR 0.59；95%CI，0.39 - 0.90；P = 0.013）。我们的研究表明，出院时使用袢利尿剂可降低HFpEF患者的早期再入院率。此外，我们的研究突出了HFpEF患者缺乏指南及治疗挑战的问题，并强调了保守治疗方法在预防HFpEF患者早期再入院方面的重要性。
