医学
利尿剂
心力衰竭
内科学
利尿剂
回顾性队列研究
人口
倾向得分匹配
危险系数
队列
临床终点
心脏病学
随机对照试验
置信区间
环境卫生
作者
Joe Cuthbert,Ireneous Soyiri,Sabrina Lomax,John Turgoose,Ahmet Fuat,Judith Cohen,Andrew L. Clark
出处
期刊:Heart
[BMJ]
日期:2024-04-17
卷期号:: heartjnl-323577
标识
DOI:10.1136/heartjnl-2023-323577
摘要
Background Loop diuretics are commonly prescribed in the community, not always to patients with a recorded diagnosis of heart failure (HF). The rate of HF events in patients prescribed loop diuretics without a diagnosis of HF is unknown. Methods This was a propensity-matched cohort study using data from the Clinical Practice Research Datalink, Hospital Episode Statistics and Office of National Statistics in the UK. Patients prescribed a loop diuretic without a diagnosis of HF (loop diuretic group) between 1 January 2010 and 31 December 2015 were compared with patients with HF (HF group)—analysis A, and patients with risk factors for HF (either ischaemic heart disease, or diabetes and hypertension—at-risk group)—analysis B. The primary endpoint was an HF event (a composite of presentation with HF symptoms, HF hospitalisation, HF diagnosis (analysis B only) and all-cause mortality). Results From a total population of 180 384 patients (78 968 in the loop diuretic group, 28 177 in the HF group and 73 239 in the at-risk group), there were 59 694 patients, 22 352 patients and 57 219 patients in the loop diuretic, HF and at-risk groups, respectively, after exclusion criteria were applied. After propensity matching for age, sex and comorbidities, patients in the loop diuretic group had a similar rate of HF events as those in the HF group (71.9% vs 72.1%; HR=0.92 (95% CI 0.90 to 0.94); p<0.001), and twice as those in the at-risk group (59.2% vs 35.7%; HR=2.04 (95% CI 2.00 to 2.08); p<0.001). Conclusions Patients prescribed a loop diuretic without a recorded diagnosis of HF experience HF events at a rate comparable with that of patients with a recorded diagnosis of HF; many of these patients may have undiagnosed HF.
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