Bullock Griffin, Jacobs Joshua A, Carey Jessica R, Pan Irene Z, Kinsey M Shea, Sideris Konstantinos, Kapelios Chris J, Stehlik Josef, Fang James C, Das Sandeep, Carter Spencer J
Department of Biomedical Sciences, Division of Clinical Informatics, Cedars Sinai Medical Center, Los Angeles, CA.
Intermountain Healthcare Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT; Department of Pharmacy, University of Utah Health, University of Utah, Salt Lake City, UT.
Am Heart J. 2025 Apr;282:30-39. doi: 10.1016/j.ahj.2024.12.010. Epub 2024 Dec 27.
Hospitalization rates for acute decompensated heart failure (ADHF) have increased, resulting in 6.5 million hospital days annually. Despite this, optimal diuretic strategies for managing ADHF remain unclear, highlighting the need to analyze diuretic practice patterns in ADHF treatment.
We performed a retrospective cohort analysis of adults hospitalized for ADHF, regardless of left ventricular ejection fraction (LVEF) between January 1, 2014 and December 21, 2021 at a large, quaternary healthcare system to determine diuretic practice patterns. We performed multivariable regression analyses to assess time to initial, second, and maximum diuretic therapy with hospital length of stay (LOS) and 30-day readmission.
Among 4,298 adults admitted for ADHF (mean age 63 years, 62 % male, 52 % LVEF ≤40 %) median time to max diuretic therapy was 1.8 (0.7, 3.8) days. Median time to initial IV loop diuretic dose was 3.6 (2.1, 6.5) hours, while time to second dose of IV loop diuretic dose was 10.2 (6.3, 15.1) hours. Time to initial IV loop diuretic, time to second IV loop diuretic dose, and time to maximum diuretic therapy were all positively associated with increased LOS but were not associated with 30-day readmission. There was wide variation in loop diuretic escalation strategies and use of sequential nephron blockade.
There was wide variation in diuretic strategies at a single academic medical center. Increased time to initial IV loop diuretic, time between diuretic doses, and longer time to max diuretic therapy were associated with increased LOS but were not associated with 30-day readmission suggesting different diuretic strategies may affect patient outcomes and warrant dedicated investigation in the future.
急性失代偿性心力衰竭（ADHF）的住院率有所上升，每年导致650万住院日。尽管如此，用于管理ADHF的最佳利尿策略仍不明确，这凸显了分析ADHF治疗中利尿实践模式的必要性。
我们对2014年1月1日至2021年12月21日期间在一个大型四级医疗系统中因ADHF住院的成年人进行了回顾性队列分析，无论其左心室射血分数（LVEF）如何，以确定利尿实践模式。我们进行了多变量回归分析，以评估开始初始、第二次和最大利尿治疗的时间与住院时间（LOS）和30天再入院率的关系。
在4298名因ADHF入院的成年人中（平均年龄63岁，62%为男性，52%的LVEF≤40%），达到最大利尿治疗的中位时间为1.8（0.7，3.8）天。开始初始静脉注射袢利尿剂剂量的中位时间为3.6（2.1，6.5）小时，而第二次静脉注射袢利尿剂剂量的时间为10.2（6.3，15.1）小时。开始初始静脉注射袢利尿剂的时间、第二次静脉注射袢利尿剂剂量的时间以及达到最大利尿治疗的时间均与住院时间延长呈正相关，但与30天再入院率无关。袢利尿剂升级策略和序贯肾单位阻断的使用存在很大差异。
在单一学术医疗中心，利尿策略存在很大差异。开始初始静脉注射袢利尿剂的时间增加、利尿剂剂量之间的时间间隔以及达到最大利尿治疗的时间延长与住院时间延长相关，但与30天再入院率无关，这表明不同的利尿策略可能会影响患者的预后，未来值得进行专门研究。
