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ID 118306
Title Alternative
Optimal medical therapy to diuretics
Author
Okushi, Yuichiro Tokushima University
Okayama, Yoshihiro Tokushima University
Zheng, Robert Tokushima University
Nakai, Michikazu National Cerebral and Cardiovascular Center
Sumita, Yoko National Cerebral and Cardiovascular Center
Keywords
heart failure
angiotensin-converting enzyme inhibitor
angiotensin receptor blocker
β-blockers
mineralocorticoid receptor antagonists
Content Type
Journal Article
Description
Background : We sought to compare the outcomes of patients receiving combination therapy of diuretics and neurohormonal blockers, with a matched cohort with monotherapy of loop diuretics, using real-world big data. Methods : This study was based on the Diagnosis Procedure Combination database in the Japanese Registry of All Cardiac and Vascular Datasets (JROAD-DPC). After exclusion criteria, we identified 78,685 patients who were first hospitalized with heart failure (HF) between April 2015 and March 2017. Propensity score (PS) was estimated with logistic regression model, with neurohormonal blockers (angiotensin-converting enzyme inhibitor : ACEi or angiotensin receptor blocker : ARB, β-blockers and mineralocorticoid receptor antagonists : MRA) as the dependent variable and 24 clinically relevant covariates to compare the in-hospital mortality between monotherapy of loop diuretics and combination therapies. Results : On PS-matched analysis, patients with ACEi / ARB, β-blockers, and MRA had lower total in-hospital mortality and in-hospital mortality within 7 days, 14 days and 30 days. In the sub-group analysis, regardless of clinical characteristics including elderly people and cancer, patients treated with a combination of loop diuretics and neurohormonal blockers had significantly lower in-hospital mortality than matched patients. Conclusions : Our data indicate the benefits of guideline-directed medical therapy to loop diuretics in the management of HF.
Journal Title
The Journal of Medical Investigation
ISSN
13496867
13431420
NCID
AA11166929
Publisher
Tokushima University Faculty of Medicine
Volume
70
Issue
1-2
Start Page
41
End Page
53
Sort Key
41
Published Date
2023-02
EDB ID
DOI (Published Version)
URL ( Publisher's Version )
FullText File
language
eng
TextVersion
Publisher
departments
University Hospital
Medical Sciences