The association between high-dose diuretics and clinical stability in ambulatory chronic heart failure patients
The association between high-dose diuretics and clinical stability in ambulatory chronic heart failure patients
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DOI：
10.1016/j.cardfail.2008.01.015
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发表时间：
2008-06-01
影响因子：
6
通讯作者：
Givertz, Michael M.
中科院分区：
文献类型：
--
作者：
Mielniczuk, Lisa M.;Tsang, Sui W.;Givertz, Michael M.
目的：在慢性心力衰竭(HF)患者中，利尿剂剂量随着病情的进展而增加，通常是在因不稳定而住院后，并与肾功能恶化和死亡率增加相关。方法和结果：对183名以利尿剂剂量(相当于小剂量80 mg速尿)为基线的晚期心力衰竭患者进行了前瞻性观察分析。所有患者均被随访1年，主要结果是心衰、心脏移植、机械心脏支持或死亡的合并心力衰竭事件。与服用小剂量利尿剂的患者(n=113)相比，服用大剂量利尿剂的患者(n=70)有更多的心血管风险增加的标志，并且更有可能有近期不稳定的病史(33%比4.4%，P<；.001)。大剂量利尿剂是后续心力衰竭事件的强大单变量预测因子(危险比3.83，95%可信区间1.82-8.54)；然而，在调整临床稳定性后，利尿剂剂量不再显著(危险比1.53，95%可信区间0.58-4.03)。结论：大剂量利尿剂可能更多地是不稳定的标志而不是原因。过去6个月心力衰竭稳定性的病史与来年发生心力衰竭事件的风险降低80%有关，与基线利尿剂剂量无关。
Objective: In chronic heart failure (HF), diuretic doses increase as the disease progresses, often after hospitalization for instability, and have been associated with worsening renal function and increased mortality.Methods and Results: A prospective observational analysis of 183 patients in an advanced HF clinic stratified at baseline by diuretic dose (low dose 80 mg furosemide equivalent) was performed. All patients were followed for 1 year, and the primary outcome was a combined HF event of admission for HF, cardiac transplant, mechanical cardiac support, or death. Compared with patients taking low-dose diuretics (n = 113), patients taking high-dose diuretics (n = 70) had more markers of increased cardiovascular risk and were more likely to have a history of recent instability (33% vs 4.4% in low dose, P < .001). High doses of diuretics were a strong univariate predictor of subsequent HF events (hazard ratio 3.83, 95% confidence interval 1.82-8.54); however, after adjustment for clinical stability, diuretic dose no longer remained significant (hazard ratio 1.53, 95% confidence interval 0.58-4.03).Conclusion: High-dose diuretics may be more of a marker than a cause of instability. A history of HF stability during the past 6 months is associated with an 80% lower risk of an HF event during the next year, independently of baseline diuretic dose.