Torsemide Versus Furosemide in Heart Failure Patients: Insights From Duke University Hospital
Torsemide Versus Furosemide in Heart Failure Patients: Insights From Duke University Hospital
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DOI：
10.1097/fjc.0000000000000212
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发表时间：
2015-05-01
影响因子：
3
通讯作者：
Velazquez, Eric J.
中科院分区：
文献类型：
--
作者：
Mentz, Robert J.;Buggey, Jonathan;Velazquez, Eric J.
尽管有数据表明托拉塞米具有潜在优势，但呋塞米历来是心力衰竭患者的主要袢利尿剂。我们使用杜克超声心动图实验室数据库调查了2000年至2010年因心力衰竭入住杜克医院并出院接受托拉塞米或呋塞米治疗的患者。我们描述了基于出院利尿剂的基线特征，并评估了5年内与全因死亡率的关系。在4580例患者中，86%（n = 3955）接受呋塞米，14%（n = 625）接受托拉塞米。与呋塞米治疗的患者相比，接受托拉塞米治疗的患者更可能是女性，并且有更多的合并症。接受托拉塞米治疗的患者的生存率更差[5年Kaplan-Meier估计生存率为41.4%（95%CI：36.7-46.0）vs. 51.5%（95%CI：49.8-53.1）]风险调整后，托拉塞米的使用不再与死亡率增加相关（风险比1.16; 95%CI：0.98-1.38; P = 0.0864）。由于潜在的残留混杂因素，需要进行前瞻性试验来研究托拉塞米与呋塞米的效果。
Furosemide has historically been the primary loop diuretic in heart failure patients despite data suggesting potential advantages with torsemide. We used the Duke Echocardiography Lab Database to investigate patients admitted with heart failure to Duke Hospital from 2000 to 2010 who were discharged on either torsemide or furosemide. We described baseline characteristics based on discharge diuretic and assessed the relationship with all-cause mortality through 5 years. Of 4580 patients, 86% (n = 3955) received furosemide and 14% (n = 625) received torsemide. Patients receiving torsemide were more likely to be female and had more comorbidities compared with furosemide-treated patients. Survival was worse in torsemide-treated patients [5-year Kaplan-Meier estimated survival of 41.4% (95% CI: 36.7-46.0) vs. 51.5% (95% CI: 49.8-53.1)] After risk adjustment, torsemide use was no longer associated with increased mortality (hazard ratio 1.16; 95% CI: 0.98-1.38; P = 0.0864). Prospective trials are needed to investigate the effect of torsemide versus furosemide because of the potential for residual confounding.