Shiraishi Yasuyuki, Kurita Yuka, Mori Hiromasa, Ooishi Kazuyuki, Matsukawa Miyuki
Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Medical Affairs, Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan.
ESC Heart Fail. 2024 Dec;11(6):4061-4070. doi: 10.1002/ehf2.15005. Epub 2024 Aug 6.
To help establish optimized treatment strategies for congestion in patients with acute heart failure, this study aimed to provide a detailed summary of real-world diuretic use in hospitalized patients with heart failure requiring urgent therapy in Japan.
This observational study used a Japanese medical records database to extract data of patients admitted to hospital with a heart failure diagnosis and an intravenous diuretic prescription from the day before admission to 2 days after. Time from hospital visit to first dose, second dose, and maximum dose of intravenous diuretics were determined. Patients were grouped according to whether they received diuretic modification, defined as an intravenous diuretic dose increase or concomitant use of other diuretics.
Overall, 1577 patients were included in the study (without diuretic modification, n = 1140 [72.3%]; with diuretic modification, n = 437 [27.7%]). The study population was 49.5% female (n = 780) and the mean age ± standard deviation was 80.1 ± 12.7 years. Intravenous diuretic treatment was received within 1 h of their hospital visit in 43.5% of patients (686/1577) and ≤2 h in 16.4% of patients (258/1577). Among 437 patients with an inadequate response following their first dose, 42.1% received an intravenous dose titration, 56.5% received combination diuretics, and 1.4% received both. Over half of the patients (59.0% [258/437]) with diuretic modification received it after the first 24 h of the hospital visit. The median time from hospital visit to first dose titration was similar to time to first combination diuretic use (18.6 h and 17.0 h, respectively). The mean ± standard deviation duration of intravenous diuretic use was significantly longer for patients with versus without diuretic modification (6.3 ± 5.2 vs. 3.7 ± 3.2 days), and a significantly greater proportion of patients (44.6% [195/437] vs. 35.0% [399/1140]) received repeated intravenous diuretic administration. Other characteristics/outcomes of intravenous diuretic use were similar with versus without diuretic modification, including in-hospital death (15.6% [68/437] vs. 13.9% [159/1140]) and mean ± standard deviation length of hospitalization (21.9 ± 14.7 days vs. 22.1 ± 21.2 days).
In Japan, real-world patterns of intravenous diuretic administration for patients with heart failure remains far from the time-sensitive approach recommended in Japanese, European, and United States guidelines.
为帮助制定急性心力衰竭患者充血的优化治疗策略，本研究旨在详细总结日本因心力衰竭住院且需要紧急治疗的患者在实际应用利尿剂的情况。
本观察性研究使用日本医疗记录数据库，提取心力衰竭诊断且从入院前一天至入院后2天有静脉利尿剂处方的住院患者数据。确定从就诊到静脉利尿剂首剂、第二剂及最大剂量的时间。根据是否接受利尿剂调整分组，利尿剂调整定义为静脉利尿剂剂量增加或同时使用其他利尿剂。
总体而言，1577例患者纳入研究（未进行利尿剂调整，n = 1140 [72.3%]；进行利尿剂调整，n = 437 [27.7%]）。研究人群中女性占49.5%（n = 780），平均年龄±标准差为80.1±12.7岁。43.5%的患者（686/1577）在就诊后1小时内接受静脉利尿剂治疗，16.4%的患者（258/1577）在≤2小时内接受治疗。在首剂后反应不足的437例患者中，42.1%接受静脉剂量滴定，56.5%接受联合利尿剂治疗，1.4%两者均接受。超过一半进行利尿剂调整的患者（59.0% [258/437]）在就诊后24小时后接受调整。从就诊到首次剂量滴定的中位时间与首次使用联合利尿剂的时间相似（分别为18.6小时和17.0小时）。进行利尿剂调整的患者静脉利尿剂使用的平均±标准差持续时间显著长于未进行调整的患者（6.3±5.2天对3.7±3.2天），且接受重复静脉利尿剂给药的患者比例显著更高（44.6% [195/437]对35.0% [399/1140]）。静脉利尿剂使用的其他特征/结局在进行与未进行利尿剂调整的患者中相似，包括院内死亡（15.6% [68/437]对13.9% [159/1140]）以及平均±标准差住院时间（21.9±14.7天对22.1±21.2天）。
在日本，心力衰竭患者静脉利尿剂给药的实际模式与日本、欧洲和美国指南推荐的时间敏感方法仍相差甚远。
