Jocelyn M Friday, John G F Cleland, Pierpaolo Pellicori, Maria K Wolters, John J V McMurray, Pardeep S Jhund, Paul Forsyth, David A McAllister, Fraser J Graham, Yola Jones, Jim Lewsey
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Outcomes were investigated using Cox models with hazard ratios adjusted for age, sex, socioeconomic deprivation, and comorbid disease (adjHR).</p><p><strong>Results: </strong>Of 198 898 patients (median age 65 years; 55% women), 161 935 (81%) neither took loop diuretics nor had a diagnostic record of heart failure (reference group), 23 963 (12%) were taking loop diuretics but had no heart failure recorded, 7844 (4%) had heart failure recorded and took loop diuretics, and 5156 (3%) had heart failure recorded but were not receiving loop diuretics. 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引用次数: 0
摘要
背景与目的:许多患者在没有心力衰竭诊断记录的情况下被处方襻利尿剂。人们对这些患者的特征和预后知之甚少:收集了格拉斯哥地区心血管疾病或服用襻利尿剂成人的健康记录(2009-2016 年)。结果:在 198,898 名患者(198,898 人)中,有 1,440,000 人(198,898 人)患有心血管疾病或服用襻利尿剂:在198,898名患者(中位年龄65岁;55%为女性)中,161,935人(81%)既没有服用襻利尿剂,也没有心衰诊断记录(参照组);23,963人(12%)服用襻利尿剂但没有心衰记录;7,844人(4%)有心衰记录并服用襻利尿剂;5,156人(3%)有心衰记录但没有服用襻利尿剂。未服用襻利尿剂的心力衰竭患者的五年死亡率仅略高于襻利尿剂(22%;adjHR:1.2 [95% CI 1.1-1.3]),服用襻利尿剂但无心力衰竭记录的患者的五年死亡率大幅高于襻利尿剂(40%;adjHR:1.8 [95% CI 1.7-1.8]),而服用襻利尿剂的心力衰竭患者的五年死亡率最高(52%;adjHR:2.2 [95% CI 2.0-2.2]):结论:对于心血管疾病患者,许多人在没有心力衰竭诊断记录的情况下被处方襻利尿剂。死亡率与使用襻利尿剂的关系比与心衰记录的关系更为密切。心力衰竭的诊断可能经常被漏诊,或者襻利尿剂的使用与预后类似于心力衰竭的其他疾病有关,或者不适当地使用襻利尿剂会增加死亡率;所有这些可能都是事实。
Loop diuretic therapy with or without heart failure: impact on prognosis.
Background and aims: Many patients are prescribed loop diuretics without a diagnostic record of heart failure. Little is known about their characteristics and prognosis.
Methods: Glasgow regional health records (2009-16) were obtained for adults with cardiovascular disease or taking loop diuretics. Outcomes were investigated using Cox models with hazard ratios adjusted for age, sex, socioeconomic deprivation, and comorbid disease (adjHR).
Results: Of 198 898 patients (median age 65 years; 55% women), 161 935 (81%) neither took loop diuretics nor had a diagnostic record of heart failure (reference group), 23 963 (12%) were taking loop diuretics but had no heart failure recorded, 7844 (4%) had heart failure recorded and took loop diuretics, and 5156 (3%) had heart failure recorded but were not receiving loop diuretics. Compared to the reference group, five-year mortality was only slightly higher for heart failure in the absence of loop diuretics [22%; adjHR 1.2 (95% CI 1.1-1.3)], substantially higher for those taking loop diuretics with no record of heart failure [40%; adjHR 1.8 (95% CI 1.7-1.8)], and highest for heart failure treated with loop diuretics [52%; adjHR 2.2 (95% CI 2.0-2.2)].
Conclusions: For patients with cardiovascular disease, many are prescribed loop diuretics without a recorded diagnosis of heart failure. Mortality is more strongly associated with loop diuretic use than with a record of heart failure. The diagnosis of heart failure may be often missed, or loop diuretic use is associated with other conditions with a prognosis similar to heart failure, or inappropriate loop diuretic use increases mortality; all might be true.
期刊介绍:
The European Heart Journal is a renowned international journal that focuses on cardiovascular medicine. It is published weekly and is the official journal of the European Society of Cardiology. This peer-reviewed journal is committed to publishing high-quality clinical and scientific material pertaining to all aspects of cardiovascular medicine. It covers a diverse range of topics including research findings, technical evaluations, and reviews. Moreover, the journal serves as a platform for the exchange of information and discussions on various aspects of cardiovascular medicine, including educational matters.
In addition to original papers on cardiovascular medicine and surgery, the European Heart Journal also presents reviews, clinical perspectives, ESC Guidelines, and editorial articles that highlight recent advancements in cardiology. Additionally, the journal actively encourages readers to share their thoughts and opinions through correspondence.