Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Duke University Medical Center, Durham, NC.
Division of Cardiology, Duke University Medical Center, Durham, NC.
Am Heart J. 2021 Sep;239:110-119. doi: 10.1016/j.ahj.2021.05.011. Epub 2021 May 27.
Decongestion is a primary goal during hospitalizations for decompensated heart failure (HF). However, data surrounding the preferred route and strategy of diuretic administration are limited with varying results in prior studies.
This is a retrospective analysis using patients from ASCEND-HF with a stable diuretic strategy in the first 24 hours following randomization. Patients were divided into three groups: intravenous (IV) continuous, IV bolus and oral strategy. Baseline characteristics, in-hospital outcomes, 30-day composite cardiovascular mortality or HF rehospitalization and 180-day all-cause mortality were compared across groups. Inverse propensity weighted modeling was used for adjustment.
Among 5,738 patients with a stable diuretic regimen in the first 24 hours (80% of overall ASCEND trial), 3,944 (68.7%) patients received IV intermittent bolus administration of diuretics, 799 (13.9%) patients received IV continuous therapy and 995 (17.3%) patients with oral administration. Patients in the IV continuous group had a higher baseline creatinine (IV continuous 1.4 [1.1-1.7]; intermittent bolus 1.2 [1.0-1.6]; oral 1.2 [1.0-1.4] mg/dL; P <0.001) and high NTproBNP (IV continuous 5,216 [2,599-11,603]; intermittent bolus 4,944 [2,339-9,970]; oral 3,344 [1,570-7,077] pg/mL; P <0.001). There was no difference between IV continuous and intermittent bolus group in weight change, total urine output and change in renal function till 10 days/discharge (adjusted P >0.05 for all). There was no difference in 30 day mortality and HF readmission (adjusted OR 1.08 [95%CI: 0.74, 1.57]; P = 0.701) and 180 days mortality (adjusted OR 1.04 [95%CI: 0.75, 1.43]; P = 0.832).
In a large cohort of patients with decompensated HF, there were no significant differences in diuretic-related in-hospital, or post-discharge outcomes between IV continuous and intermittent bolus administration. Tailoring appropriate diuretic strategy to different states of acute HF and congestion phenotypes needs to be further investigated.
失代偿性心力衰竭（HF）住院期间的主要目标是去充血。然而，关于利尿剂给药首选途径和策略的数据有限，先前的研究结果存在差异。
这是一项回顾性分析，使用 ASCEND-HF 试验中随机分组后 24 小时内稳定利尿剂方案的患者。患者分为三组：静脉（IV）连续、IV 推注和口服策略。比较各组间基线特征、住院期间结局、30 天复合心血管死亡率或 HF 再住院和 180 天全因死亡率。采用逆概率加权模型进行调整。
在 ASCEND 试验的前 24 小时内接受稳定利尿剂治疗的 5738 例患者中（占总体 ASCEND 试验的 80%），3944 例（68.7%）患者接受 IV 间断推注利尿剂治疗，799 例（13.9%）患者接受 IV 连续治疗，995 例（17.3%）患者接受口服治疗。IV 连续组患者的基线肌酐水平较高（IV 连续 1.4[1.1-1.7]mg/dL；间歇推注 1.2[1.0-1.6]mg/dL；口服 1.2[1.0-1.4]mg/dL；P<0.001），NTproBNP 水平较高（IV 连续 5216[2599-11603]pg/mL；间歇推注 4944[2339-9970]pg/mL；口服 3344[1570-7077]pg/mL；P<0.001）。直到第 10 天/出院时，IV 连续组和间断推注组的体重变化、总尿量和肾功能变化无差异（所有调整后 P>0.05）。30 天死亡率和 HF 再入院率（调整后 OR 1.08[95%CI：0.74，1.57]；P=0.701）和 180 天死亡率（调整后 OR 1.04[95%CI：0.75，1.43]；P=0.832）无差异。
在大量失代偿性 HF 患者中，IV 连续输注和间断推注利尿剂给药与住院期间或出院后利尿剂相关结局无显著差异。需要进一步研究针对急性 HF 不同状态和充血表型的适当利尿剂策略。
