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Early diuretic strategies and the association with In-hospital and Post-discharge outcomes in acute heart failure.
Fudim, Marat; Spates, Toi; Sun, Jie-Lena; Kittipibul, Veraprapas; Testani, Jeffrey M; Starling, Randall C; Tang, W H Wilson; Hernandez, Adrian F; Felker, G Michael; O'Connor, Christopher M; Mentz, Robert J.
Afiliação
  • Fudim M; Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Duke University Medical Center, Durham, NC. Electronic address: marat.fudim@duke.edu.
  • Spates T; Division of Cardiology, Duke University Medical Center, Durham, NC.
  • Sun JL; Duke Clinical Research Institute, Durham, NC.
  • Kittipibul V; Department of Medicine, University of Miami, Miami, Fl.
  • Testani JM; Division of Cardiology, Yale, New Haven.
  • Starling RC; Division of Cardiology, Cleveland Clinic, Cleveland, OH.
  • Tang WHW; Division of Cardiology, Cleveland Clinic, Cleveland, OH.
  • Hernandez AF; Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Duke University Medical Center, Durham, NC.
  • Felker GM; Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Duke University Medical Center, Durham, NC.
  • O'Connor CM; Inova Heart and Vascular Institute, Falls Church, VA.
  • Mentz RJ; Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Duke University Medical Center, Durham, NC.
Am Heart J ; 239: 110-119, 2021 09.
Article em En | MEDLINE | ID: mdl-34052212
BACKGROUND: Decongestion is a primary goal during hospitalizations for decompensated heart failure (HF). However, data surrounding the preferred route and strategy of diuretic administration are limited with varying results in prior studies. METHODS: This is a retrospective analysis using patients from ASCEND-HF with a stable diuretic strategy in the first 24 hours following randomization. Patients were divided into three groups: intravenous (IV) continuous, IV bolus and oral strategy. Baseline characteristics, in-hospital outcomes, 30-day composite cardiovascular mortality or HF rehospitalization and 180-day all-cause mortality were compared across groups. Inverse propensity weighted modeling was used for adjustment. RESULTS: Among 5,738 patients with a stable diuretic regimen in the first 24 hours (80% of overall ASCEND trial), 3,944 (68.7%) patients received IV intermittent bolus administration of diuretics, 799 (13.9%) patients received IV continuous therapy and 995 (17.3%) patients with oral administration. Patients in the IV continuous group had a higher baseline creatinine (IV continuous 1.4 [1.1-1.7]; intermittent bolus 1.2 [1.0-1.6]; oral 1.2 [1.0-1.4] mg/dL; P <0.001) and high NTproBNP (IV continuous 5,216 [2,599-11,603]; intermittent bolus 4,944 [2,339-9,970]; oral 3,344 [1,570-7,077] pg/mL; P <0.001). There was no difference between IV continuous and intermittent bolus group in weight change, total urine output and change in renal function till 10 days/discharge (adjusted P >0.05 for all). There was no difference in 30 day mortality and HF readmission (adjusted OR 1.08 [95%CI: 0.74, 1.57]; P = 0.701) and 180 days mortality (adjusted OR 1.04 [95%CI: 0.75, 1.43]; P = 0.832). CONCLUSION: In a large cohort of patients with decompensated HF, there were no significant differences in diuretic-related in-hospital, or post-discharge outcomes between IV continuous and intermittent bolus administration. Tailoring appropriate diuretic strategy to different states of acute HF and congestion phenotypes needs to be further investigated.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infusões Intravenosas / Furosemida / Insuficiência Cardíaca / Injeções Intravenosas Tipo de estudo: Clinical_trials / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged País como assunto: America do norte Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infusões Intravenosas / Furosemida / Insuficiência Cardíaca / Injeções Intravenosas Tipo de estudo: Clinical_trials / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged País como assunto: America do norte Idioma: En Ano de publicação: 2021 Tipo de documento: Article