Use of short-acting vs. long-acting loop diuretics after heart failure hospitalization.
Use of short-acting vs. long-acting loop diuretics after heart failure hospitalization.
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DOI：
10.1002/ehf2.14030
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发表时间：
2022-10
影响因子：
3.8
通讯作者：
Yoshikawa T
中科院分区：
文献类型：
--
作者：
Imaeda S;Shiraishi Y;Kohsaka S;Niimi N;Goda A;Nagatomo Y;Takei M;Saji M;Nakano S;Kohno T;Fukuda K;Yoshikawa T
呋塞米是一种短效袢利尿剂（SD），在临床实践中是治疗心力衰竭（HF）的主要处方药。然而，越来越多的数据表明，长效袢利尿剂（LD），如托拉塞米或阿佐塞米，可能具有更有利的药理学特性。本研究旨在调查在一项当代多中心注册研究中，因急性心力衰竭住院的患者所使用的袢利尿剂类型与长期预后之间的关系。
在2006年至2017年的西东京心力衰竭注册研究中，共对2680名患者（60.1%为男性，中位年龄77岁）进行了分析。根据出院时使用的利尿剂类型对患者进行分类；2073人（77.4%）使用短效利尿剂，607人（22.6%）使用长效利尿剂。主要终点是出院后全因死亡或心力衰竭再入院的复合事件，次要终点分别是全因死亡和心力衰竭再入院。在中位随访期2.1年期间，639名患者死亡[短效利尿剂组n = 519（25.0%）；长效利尿剂组n = 120（19.8%）]，868名患者因心力衰竭再入院[短效利尿剂组n = 697（33.6%）；长效利尿剂组n = 171（28.2%）]。经过多变量调整后，长效利尿剂组发生复合终点事件的风险较低[风险比（HR），0.80；95%置信区间（CI），0.66 - 0.96；P = 0.017]，包括全因死亡（HR；0.73；95% CI；0.54 - 0.99；P = 0.044）和心力衰竭再入院（HR，0.81；95% CI，0.66 - 0.99；P = 0.038），均低于短效利尿剂组。倾向评分匹配得出的估计值与多变量分析的结果一致，亚组分析表明，长效利尿剂的使用主要在射血分数降低的年轻患者中与较好的预后相关。
长效利尿剂与心力衰竭且近期有急性失代偿发作的患者的长期预后风险较低相关。
Furosemide, a short‐acting loop diuretic (SD), is the dominant agent prescribed for heart failure (HF) in clinical practice. However, accumulating data suggests that long‐acting loop diuretics (LD), such as torsemide or azosemide, might have more favourable pharmacological profiles. This study aimed to investigate the relationship between the type of loop diuretics and long‐term outcomes among patients hospitalized for acute HF enrolled in a contemporary multicentre registry. Within the West Tokyo Heart Failure Registry from 2006 to 2017, a total of 2680 patients (60.1% men with a median age of 77 years) were analysed. The patients were characterized by the type of diuretics used at the time of discharge; 2073 (77.4%) used SD, and 607 (22.6%) used LD. The primary endpoint was composite of all‐cause death or HF re‐admission after discharge, and the secondary endpoints were all‐cause death and HF re‐admission, respectively. During the median follow‐up period of 2.1 years, 639 patients died [n = 519 (25.0%) in the SD group; n = 120 (19.8%) in the LD group], and 868 patients were readmitted for HF [n = 697 (33.6%) in the SD group; n = 171 (28.2%) in the LD group]. After multivariable adjustment, the LD group had lower risk for the composite outcome [hazard ratio (HR), 0.80; 95% confidence interval (CI), 0.66–0.96; P = 0.017], including all‐cause death (HR; 0.73; 95% CI; 0.54–0.99; P = 0.044) and HF re‐admission (HR, 0.81; 95% CI, 0.66–0.99; P = 0.038), than the SD group. Propensity score matching yielded estimates that were consistent with those of the multivariable analyses, with sub‐group analyses demonstrating that use of LD was associated with favourable outcomes predominantly in younger patients with reduced ejection fraction. LD was associated with lower risk of long‐term outcomes in patients with HF and a recent episode of acute decompensation.
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DOI：
10.1016/s0735-1097(03)00765-4
发表时间：
2003-08-20
影响因子：
24
作者：
Domanski, M;Norman, J;Peyster, E
通讯作者：
Peyster, E
影响因子：
3
作者：
Tsutsui, T;Tsutamoto, T;Kinoshita, M
通讯作者：
Kinoshita, M
影响因子：
3.3
作者：
Masuyama, Tohru;Tsujino, Takeshi;Ito, Hiroshi
通讯作者：
Ito, Hiroshi
影响因子：
5
作者：
UCHIDA, T;YAMANAGA, K;WATANABE, M
通讯作者：
WATANABE, M
影响因子：
2.8
作者：
Abraham, Bishoy;Megaly, Michael;Sharma, Rajaninder
通讯作者：
Sharma, Rajaninder