Diuretic dose and long-term outcomes in elderly patients with heart failure after hospitalization
Diuretic dose and long-term outcomes in elderly patients with heart failure after hospitalization
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DOI：
10.1016/j.ahj.2010.05.032
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发表时间：
2010-08-01
影响因子：
4.8
通讯作者：
Lee, Douglas S.
中科院分区：
文献类型：
--
作者：
Abdel-Qadir, Husam M.;Tu, Jack V.;Lee, Douglas S.
根据纵向速尿剂量对心力衰竭（HF）的一系列结果尚未进行评估。我们研究了动态速尿剂量与死亡率、心血管疾病和肾功能障碍住院率的关系。方法对新出院的老年HF患者（>= 65岁），使用安大略省药物福利数据库，通过检查随访5年的剂量波动来确定动态呋塞米暴露。动态速尿暴露分为低剂量（LD; 1-59 mg/d）、中剂量（MD; 60-119 mg/d）和高剂量（HD; >= 120 mg/d）。通过将速尿暴露建模为时间相关协变量来评估结果。结果4406例患者（78.4±7.0岁，男性50.5%）中，46%的患者在1年内改变了呋塞米的剂量类别，63%的患者在随访期间改变了剂量类别。与LD相比，大剂量氟化尿患者更年轻，主要是男性，表现出更多的缺血性或瓣膜性疾病、糖尿病、心房颤动、低血压、低钠血症和较高的基线肌酐。与LD相比，MD暴露与死亡率增加相关，校正风险比为1.96 (95% CI 1.79-2.15)，而HD暴露具有更高的死亡率风险，经多变量调整后，风险比为3.00 （95% CI 2.72-3.31）
Background The array of outcomes according to longitudinal furosemide doses in heart failure (HF) have not been evaluated. We examined the relationship of dynamic furosemide dose with mortality and hospitalizations for cardiovascular disease and renal dysfunction.Methods Among elderly patients with HF (>= 65 years) newly discharged from hospital, dynamic furosemide exposure was determined by examining dose fluctuations up to 5 years of follow-up using the Ontario Drug Benefit pharmacare database. Dynamic furosemide exposures were classified as low dose (LD; 1-59 mg/d), medium dose (MD; 60-119 mg/d), or high dose (HD; >= 120 mg/d). Outcomes were assessed by modeling furosemide exposure as a time-dependent covariate.Results Among 4,406 patients (78.4 +/- 7.0 years; 50.5% male), 46% changed furosemide dose categories within 1 year, and 63% changed dose categories over the follow-up period. High-dose furosemide patients were younger, were mostly male, and exhibited more ischemic or valvular disease, diabetes, atrial fibrillation, hypotension, hyponatremia, and higher baseline creatinine than LD. Compared with LD, MD exposure was associated with increased mortality with adjusted hazard ratio 1.96 (95% CI 1.79-2.15), whereas HD exposure conferred greater mortality risk with hazard ratio 3.00 (95% CI 2.72-3.31) after multiple covariate adjustment (both P