心力衰竭失代偿出院患者中噻嗪类利尿剂联合袢利尿剂与 30 天结局的相关性。
Combining loop with thiazide diuretics in patients discharged home after a heart failure decompensation: Association with 30-day outcomes.
机构信息
Emergency Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain; The GREAT network, Rome, Italy.
Cardiology Department, Hospital Clínico de Valencia, INCLIVA, Valencia, Spain.
出版信息
Eur J Intern Med. 2024 Sep;127:126-133. doi: 10.1016/j.ejim.2024.05.009. Epub 2024 May 19.
OBJECTIVE
To investigate the association of the addition of thiazide diuretic on top of loop diuretic and standard of care with short-term outcomes of patients discharged after surviving an acute heart failure (AHF) episode.
METHODS
This is a secondary analysis of 14,403 patients from three independent cohorts representing the main departments involved in AHF treatment for whom treatment at discharge was recorded and included loop diuretics. Patients were divided according to whether treatment included or not thiazide diuretics. Short-term outcomes consisted of 30-day all-cause mortality, hospitalization (with a separate analysis for hospitalization due to AHF or to other causes) and the combination of death and hospitalization. The association between thiazide diuretics on short-term outcomes was explored by Cox regression and expressed as hazard ratios (HR) with 95 % confidence intervals, which were adjusted for 18 patient-related variables and 9 additional drugs (aside from loop and thiazide diuretics) prescribed at discharge.
RESULTS
The median age was 81 (interquartile range=73-86) years, 53 % were women, and patients were mainly discharged from the cardiology (42 %), internal medicine or geriatric department (29 %) and emergency department (19 %). There were 1,367 patients (9.5 %) discharged with thiazide and loop diuretics, while the rest (13,036; 90.5 %) were discharged with only loop diuretics on top of the remaining standard of care treatments. The combination of thiazide and loop diuretics showed a neutral effect on all outcomes: death (adjusted HR 1.149, 0.850-1.552), hospitalization (0.898, 0.770-1.048; hospitalization due to AHF 0.799, 0.599-1.065; hospitalization due to other causes 1.136, 0.756-1.708) and combined event (0.934, 0.811-1.076).
CONCLUSION
The combination of thiazide and loop diuretics was not associated with changes in risk of death, hospitalization or a combination of both.
目的
研究在标准治疗基础上加用噻嗪类利尿剂与单纯使用袢利尿剂对急性心力衰竭（AHF）出院后患者短期结局的影响。
方法
本研究对来自三个独立队列的 14403 名患者进行了二次分析，这些患者代表了参与 AHF 治疗的主要科室，记录了出院时的治疗情况，并包括袢利尿剂。根据治疗是否包含噻嗪类利尿剂，患者被分为两组。短期结局包括 30 天全因死亡率、住院（对因 AHF 住院和因其他原因住院分别进行了分析）和死亡与住院的组合。通过 Cox 回归探讨噻嗪类利尿剂与短期结局的关系，并以风险比（HR）及其 95%置信区间表示，该 HR 经过 18 项患者相关变量和 9 种除袢利尿剂和噻嗪类利尿剂以外的额外出院时开具的药物调整。
结果
中位年龄为 81（73-86）岁，53%为女性，患者主要从心内科（42%）、内科或老年科（29%）和急诊科（19%）出院。有 1367 名患者（9.5%）出院时使用了噻嗪类利尿剂和袢利尿剂，其余 13036 名患者（90.5%）出院时仅使用了袢利尿剂，加上其余标准治疗药物。噻嗪类利尿剂和袢利尿剂联合使用对所有结局均无影响：死亡（调整 HR 1.149，0.850-1.552）、住院（0.898，0.770-1.048；因 AHF 住院 0.799，0.599-1.065；因其他原因住院 1.136，0.756-1.708）和联合事件（0.934，0.811-1.076）。
结论
噻嗪类利尿剂和袢利尿剂联合使用与死亡、住院或两者兼有的风险增加无关。
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