Department of Internal Medicine, Section of Cardiovascular Medicine (J.B.I.-M., V.S.R., J.M.-V., D.M., C.M., L.B., J.M. Testani), Yale University School of Medicine, New Haven, CT.
Hospital de Cardiología, Instituto Mexicano del Seguro Social, Mexico City (J.B.I.-M.).
Circ Heart Fail. 2023 Apr;16(4):e010206. doi: 10.1161/CIRCHEARTFAILURE.122.010206. Epub 2023 Mar 10.
Following treatment for acute decompensated heart failure, in-hospital observation on oral diuretics (OOD) is recommended, assuming it provides actionable information on discharge diuretic dosing and thus reduces readmissions.
In the Mechanisms of Diuretic Resistance (MDR) cohort, we analyzed in-hospital measures of diuretic response, provider's decisions, and diuretic response ≈30 days postdischarge. In a Yale multicenter cohort, we assessed if in-hospital OOD was associated with 30-day readmission risk. The main objective of this study was to evaluate the utility of in-hospital OOD.
Of the 468 patients in the MDR cohort, 57% (N=265) underwent in-hospital OOD. During the OOD, weight change and net fluid balance correlated poorly with each other (=0.36). Discharge diuretic dosing was similar between patients who had increased, stable, or decreased weight (decreased discharge dose from OOD dose in 77% versus 72% versus 70%, respectively), net fluid status (decreased discharge dose from OOD dose in 100% versus 69% versus 74%, respectively), and urine output (decreased discharge dose from OOD dose in 69% versus 79% versus 72%, respectively) during the 24-hour OOD period (>0.27 for all). In participants returning at 30 days for formal quantification of outpatient diuretic response (n=98), outpatient and inpatient OOD natriuresis was poorly correlated (=0.26). In the Yale multicenter cohort (n=18 454 hospitalizations), OOD occurred in 55% and was not associated with 30-day hospital readmission (hazard ratio, 0.98 [95% CI, 0.93-1.05]; =0.51).
In-hospital OOD did not provide actionable information on diuretic response, was not associated with outpatient dose selection, did not predict subsequent outpatient diuretic response, and was not associated with lower readmission rate. Additional research is needed to replicate these findings and understand if these resources could be better allocated elsewhere.
URL: https://www.
gov; Unique identifier: NCT02546583.
急性失代偿性心力衰竭治疗后，建议住院观察口服利尿剂（OOD），因为它可以提供有关出院时利尿剂剂量的可操作信息，从而降低再入院率。
在利尿剂抵抗机制（MDR）队列中，我们分析了住院期间利尿剂反应的措施、提供者的决策以及出院后约 30 天的利尿剂反应。在耶鲁大学多中心队列中，我们评估了住院期间 OOD 是否与 30 天再入院风险相关。本研究的主要目的是评估住院期间 OOD 的效用。
在 MDR 队列的 468 名患者中，57%（N=265）接受了住院期间 OOD。在 OOD 期间，体重变化和净液体平衡之间相关性较差（=0.36）。在体重增加、稳定或减轻的患者中，出院时的利尿剂剂量相似（从 OOD 剂量减少的出院剂量分别为 77%、72%和 70%），净液体状态（从 OOD 剂量减少的出院剂量分别为 100%、69%和 74%），以及 24 小时 OOD 期间的尿量（从 OOD 剂量减少的出院剂量分别为 69%、79%和 72%）（所有 P 值均>0.27）。在 98 名返回 30 天进行门诊利尿剂反应正式定量评估的参与者中，门诊和住院 OOD 排钠作用相关性较差（=0.26）。在耶鲁大学多中心队列（n=18454 例住院患者）中，OOD 发生率为 55%，与 30 天内医院再入院无关（风险比，0.98[95%CI，0.93-1.05]；=0.51）。
住院期间 OOD 并未提供有关利尿剂反应的可操作信息，与门诊剂量选择无关，无法预测随后的门诊利尿剂反应，也与较低的再入院率无关。需要进一步研究来复制这些发现，并了解这些资源是否可以更好地分配到其他地方。
gov；唯一标识符：NCT02546583。
