Koike Toshiharu, Suzuki Atsushi, Kikuchi Noriko, Yoshimura Asami, Haruki Kaoru, Yoshida Ayano, Sone Maiko, Nakazawa Mayui, Tsukamoto Kei, Imamura Yasutaka, Hattori Hidetoshi, Kogure Tomohito, Yamaguchi Junichi, Shiga Tsuyoshi
Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
Int J Cardiol Heart Vasc. 2024 Sep 24;55:101517. doi: 10.1016/j.ijcha.2024.101517. eCollection 2024 Dec.
The relationship between patterns of outpatient oral loop diuretic (LD) dose reduction and prognosis in patients with heart failure (HF) remains unclear.
We evaluated 679 patients with HF-prescribed LDs at baseline between September 2015 and August 2019. Dose reduction was defined as a change to a lower LD dose than the previous outpatient dose. Dose intensification was defined as a change to a higher LD dose than the previous outpatient dose. Patients were classified into no-reduction (no LD dose reduction during follow-up) and reduction groups (categorized into successive-reduction [≥2 successive LD dose reductions without intervening LD dose intensification] and single-reduction [LD dose reduction without successive dose reduction] groups). The primary outcomes were all-cause death, HF hospitalization (HFH), and the composite of cardiovascular death (CVD) or HFH.
Within a median follow-up of 53.7 (range, 2.6-99.1) months, 156 deaths were recorded: 121 (29 %), 31 (15 %), and three (4 %) patients in the no-reduction (n = 411), single-reduction (n = 195), and successive-reduction (n = 73) groups, respectively. After adjusting for cofounders, the reduction group had a lower risk of primary outcomes than the no reduction group (all-cause death: hazard ratio (HR) = 0.65, 95 % confidence interval (CI) = 0.44-0.96; CVD or HFH: HR=0.69, 95 %CI=0.52-0.93; HFH: HR=0.69, 95 % CI=0.52-0.93). The successive-reduction group had a lower risk of the composite of CVD or HFH (HR=0.26, 95 % CI: 0.10-0.67) and HFH (HR=0.34, 95 % CI=0.13-0.86) than the single-reduction group.
Outpatient LD dose reduction patterns can be indicators of good prognosis in HF patients.
门诊口服袢利尿剂（LD）剂量减少模式与心力衰竭（HF）患者预后之间的关系尚不清楚。
我们评估了2015年9月至2019年8月期间679例基线时接受LD治疗的HF患者。剂量减少定义为改为低于先前门诊剂量的LD剂量。剂量增加定义为改为高于先前门诊剂量的LD剂量。患者分为未减少组（随访期间未进行LD剂量减少）和减少组（分为连续减少组[≥2次连续LD剂量减少且无中间LD剂量增加]和单次减少组[LD剂量减少但无连续剂量减少]）。主要结局为全因死亡、HF住院（HFH）以及心血管死亡（CVD）或HFH的复合结局。
在中位随访53.7（范围2.6 - 99.1）个月期间，记录了156例死亡：未减少组（n = 411）中有121例（29%）、单次减少组（n = 195）中有31例（15%）、连续减少组（n = 73）中有3例（4%）。在对混杂因素进行校正后，减少组的主要结局风险低于未减少组（全因死亡：风险比（HR）= 0.65，95%置信区间（CI）= 0.44 - 0.96；CVD或HFH：HR = 0.69，95%CI = 0.52 - 0.93；HFH：HR = 0.69，95%CI = 0.52 - 0.93）。连续减少组的CVD或HFH复合结局（HR = 0.26，95%CI：0.10 - 0.67）和HFH（HR = 0.34，95%CI = 0.13 - 0.86）风险低于单次减少组。
门诊LD剂量减少模式可作为HF患者预后良好的指标。
