Benefits of guideline-directed medical therapy to loop diuretics in management of heart failure
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- Kusunose Kenya
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
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- Okushi Yuichiro
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
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- Okayama Yoshihiro
- Clinical Research Center for Developmental Therapeutics, Tokushima University Hospital, Tokushima, Japan
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- Zheng Robert
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
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- Nakai Michikazu
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan
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- Sumita Yoko
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan
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- Ise Takayuki
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
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- Yamaguchi Koji
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
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- Yagi Shusuke
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
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- Yamada Hirotsugu
- Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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- Soeki Takeshi
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
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- Wakatsuki Tetsuzo
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
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- Sata Masataka
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
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説明
<p>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, ?-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, ?-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. J. Med. Invest. 70 : 41-53, February, 2023</p>
収録刊行物
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- The Journal of Medical Investigation
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The Journal of Medical Investigation 70 (1.2), 41-53, 2023
国立大学法人 徳島大学医学部