Jacobs Joshua A, Carter Spencer J, Bullock Griffin, Carey Jessica R, Pan Irene Z, Kinsey M Shea, Zheutlin Alexander R, Kapelios Chris J, Raju Shilpa, Fang James C, Shah Kevin S, Bress Adam P
Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA.
Department of Pharmacy, University of Utah Health, University of Utah, Salt Lake City, Utah, USA.
JACC Adv. 2024 Sep 7;3(10):101250. doi: 10.1016/j.jacadv.2024.101250. eCollection 2024 Oct.
Nearly one-half of patients admitted with acute decompensated heart failure (ADHF) are discharged with unresolved congestion, elevating rehospitalization risk. This may be due to suboptimal intravenous (IV) loop diuretic dosing, which may be influenced by home oral diuretic dose.
The objective of this study was to determine the association between: 1) home oral loop diuretic dose and optimal initial IV loop diuretic dosing in ADHF; and 2)receiving optimal initial IV loop diuretic dosing and length of stay and 30-day readmission.
Retrospective analysis of adults admitted to a large U.S. hospital for ADHF on home oral loop diuretics from 1 January 2014 to 21 December 2021. Patients were categorized by home dose: low (≤40 mg furosemide equivalents), medium (>40-80 mg furosemide equivalents), and high (>80 mg furosemide equivalents). Optimal initial IV dosing was considered ≥2 times home oral dosing. Poisson regression models estimated prevalence ratios (CIs) for optimal initial IV loop diuretic dosing.
Among 3,269 adults admitted for ADHF (mean age 63 years, 62% male), optimal initial IV dosing occurred in 2,218 (67.9%). The prevalence of optimal initial IV dosing among low, medium, and high home dosing was 95.5%, 59.9%, and 4.0%, respectively. Adjusted prevalence ratios for optimal IV dosing with high and medium home dosing, compared to low, were 0.05 (95% CI: 0.03-0.07) and 0.66 (95% CI: 0.62-0.70), respectively. There was no difference in length of stay or 30-day readmission between optimal and suboptimal initial IV diuretic dosing.
Among patients with ADHF, higher home loop diuretic dose was strongly associated with a substantially lower likelihood of optimal initial IV diuretic dosing.
近一半因急性失代偿性心力衰竭（ADHF）入院的患者出院时仍有未缓解的充血症状，这增加了再次住院的风险。这可能是由于静脉注射（IV）袢利尿剂剂量未达最佳，而这可能受到家庭口服利尿剂剂量的影响。
本研究的目的是确定以下因素之间的关联：1）家庭口服袢利尿剂剂量与ADHF患者最佳初始静脉注射袢利尿剂剂量；2）接受最佳初始静脉注射袢利尿剂剂量与住院时间和30天再入院率。
对2014年1月1日至2021年12月21日期间在美国一家大型医院因ADHF接受家庭口服袢利尿剂治疗的成年人进行回顾性分析。患者按家庭剂量分类：低剂量（≤40毫克速尿当量）、中等剂量（>40 - 80毫克速尿当量）和高剂量（>80毫克速尿当量）。最佳初始静脉注射剂量被认为≥家庭口服剂量的2倍。泊松回归模型估计最佳初始静脉注射袢利尿剂剂量的患病率比（置信区间）。
在3269名因ADHF入院的成年人中（平均年龄63岁，62%为男性），2218人（67.9%）出现了最佳初始静脉注射剂量。低、中、高家庭剂量组中最佳初始静脉注射剂量的患病率分别为95.5%、59.9%和4.0%。与低家庭剂量组相比，高家庭剂量组和中家庭剂量组最佳静脉注射剂量的校正患病率比分别为0.05（95%置信区间：0.03 - 0.07）和0.66（95%置信区间：0.62 - 0.70）。最佳和次佳初始静脉注射利尿剂剂量在住院时间或30天再入院率方面没有差异。
在ADHF患者中，较高的家庭袢利尿剂剂量与最佳初始静脉注射利尿剂剂量的可能性显著降低密切相关。
