Isogai Toshiaki, Morita Kojiro, Okada Akira, Michihata Nobuaki, Matsui Hiroki, Miyawaki Atsushi, Yasunaga Hideo
Department of Cardiology, Tokyo Metropolitan Tama Medical Center Tokyo Japan.
Department of Health Services Research, Graduate School of Medicine, The University of Tokyo Tokyo Japan.
Circ Rep. 2025 Jan 21;7(2):86-96. doi: 10.1253/circrep.CR-24-0114. eCollection 2025 Feb 10.
Constipation commonly coexists with heart failure (HF) and can increase blood pressure because of straining during defecation and accompanying mental stress. Daikenchuto, a Japanese herbal medicine to ameliorate gastrointestinal motility, may be effective as a complement to laxatives in improving outcomes in patients with HF and constipation.
We used the Diagnosis Procedure Combination database to identify patients aged ≥65 years who were admitted for HF, had constipation, and were discharged alive between April 2016 and March 2022. We divided the 115,544 eligible patients into 2 groups according to the prescription of Daikenchuto in addition to laxatives at discharge and compared the incidence of 1-year HF readmission using 1 : 4 propensity score matching. Daikenchuto was prescribed at discharge in 3,315 (2.9%) patients. In the unmatched cohort, patients treated with Daikenchuto were more often male and had a higher prevalence of malignancy than those treated without Daikenchuto. In the 1 : 4 propensity score-matched cohort (3,311 and 13,243 patients with and without Daikenchuto, respectively), no significant difference was noted in 1-year HF readmission between the groups (22.2% vs. 21.9%; hazard ratio=1.02, 95% confidence interval=0.94-1.11). This result was consistent across clinically relevant subgroups except for renal disease.
Complementary use of Daikenchuto in combination with laxatives was not associated with a lower incidence of HF readmission in patients with HF and constipation.
便秘常与心力衰竭（HF）并存，且因排便时用力及伴随的精神压力可导致血压升高。大建中汤是一种改善胃肠动力的日本草药，作为泻药的补充，可能对改善HF合并便秘患者的预后有效。
我们使用诊断程序组合数据库，识别2016年4月至2022年3月期间因HF入院、患有便秘且出院时存活的≥65岁患者。我们根据出院时除泻药外是否开具大建中汤，将115544例符合条件的患者分为两组，并使用1:4倾向评分匹配比较1年HF再入院发生率。3315例（2.9%）患者出院时开具了大建中汤。在未匹配队列中，接受大建中汤治疗的患者男性更多，恶性肿瘤患病率高于未接受大建中汤治疗的患者。在1:4倾向评分匹配队列（分别为3311例和13243例接受和未接受大建中汤治疗的患者）中，两组间1年HF再入院率无显著差异（22.2%对21.9%；风险比=1.02，95%置信区间=0.94-1.11）。除肾病外，这一结果在各临床相关亚组中均一致。
大建中汤与泻药联合使用，对于HF合并便秘患者，并未降低HF再入院率。
