Clinical Sciences Centre, Hull York Medical School, University of Hull, Hull, UK
Department of Cardiology, Castle Hill Hospital, Cottingham, UK.
Heart. 2024 May 23;110(12):854-862. doi: 10.1136/heartjnl-2023-323577.
Loop diuretics are commonly prescribed in the community, not always to patients with a recorded diagnosis of heart failure (HF). The rate of HF events in patients prescribed loop diuretics without a diagnosis of HF is unknown.
This was a propensity-matched cohort study using data from the Clinical Practice Research Datalink, Hospital Episode Statistics and Office of National Statistics in the UK. Patients prescribed a loop diuretic without a diagnosis of HF (loop diuretic group) between 1 January 2010 and 31 December 2015 were compared with patients with HF (HF group)-analysis A, and patients with risk factors for HF (either ischaemic heart disease, or diabetes hypertension-at-risk group)-analysis B. The primary endpoint was an HF event (a composite of presentation with HF symptoms, HF hospitalisation, HF diagnosis (analysis B only) and all-cause mortality).
From a total population of 180 384 patients (78 968 in the loop diuretic group, 28 177 in the HF group and 73 239 in the at-risk group), there were 59 694 patients, 22 352 patients and 57 219 patients in the loop diuretic, HF and at-risk groups, respectively, after exclusion criteria were applied. After propensity matching for age, sex and comorbidities, patients in the loop diuretic group had a similar rate of HF events as those in the HF group (71.9% vs 72.1%; HR=0.92 (95% CI 0.90 to 0.94); p<0.001), and twice as those in the at-risk group (59.2% vs 35.7%; HR=2.04 (95% CI 2.00 to 2.08); p<0.001).
Patients prescribed a loop diuretic without a recorded diagnosis of HF experience HF events at a rate comparable with that of patients a recorded diagnosis of HF; many of these patients may have undiagnosed HF.
在社区中，常为没有心力衰竭（HF）记录诊断的患者开环利尿剂，但不知道在没有 HF 诊断的情况下开具环利尿剂的患者 HF 事件的发生率。
这是一项使用英国临床实践研究数据库、医院住院统计数据和国家统计局数据的倾向匹配队列研究。2010 年 1 月 1 日至 2015 年 12 月 31 日期间，未诊断为 HF 而开具环利尿剂的患者（环利尿剂组）与 HF 患者（HF 组）-分析 A 相比，以及具有 HF 危险因素（缺血性心脏病或糖尿病和高血压-高危组）-分析 B 的患者相比。主要终点是 HF 事件（HF 症状发作、HF 住院、HF 诊断（仅分析 B）和全因死亡率的复合终点）。
在总共 180384 名患者中（环利尿剂组 78968 名，HF 组 28177 名，高危组 73239 名），排除标准后，环利尿剂组、HF 组和高危组分别有 59694 名、22352 名和 57219 名患者。在年龄、性别和合并症的倾向匹配后，与 HF 组相比，环利尿剂组患者的 HF 事件发生率相似（71.9%比 72.1%；HR=0.92（95%CI 0.90 至 0.94）；p<0.001），与高危组相比则高出两倍（59.2%比 35.7%；HR=2.04（95%CI 2.00 至 2.08）；p<0.001）。
未记录 HF 诊断而开具环利尿剂的患者发生 HF 事件的发生率与记录 HF 诊断的患者相当；其中许多患者可能患有未诊断的 HF。
