医学
减肥
失代偿
危险系数
心力衰竭
四分位间距
急性失代偿性心力衰竭
置信区间
心脏失代偿
内科学
体重增加
外科
体重
肥胖
作者
Gauravpal S. Gill,Phillip H. Lam,Vijaywant Brar,Samir S. Patel,Cherinne Arundel,Prakash Deedwania,Charles Faselis,Richard M. Allman,Sijian Zhang,Charity Morgan,Gregg C. Fonarow,Ali Ahmed
标识
DOI:10.1016/j.cardfail.2021.11.017
摘要
Background Acute decompensation of heart failure (HF) is often marked by fluid retention, and weight loss is a marker of successful diuresis. We examined the relationship between in-hospital weight loss and post-discharge outcomes in patients with HF. Methods We conducted a propensity score-matched study of 8830 patients hospitalized for decompensated HF in the Medicare-linked Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry, in which 4415 patients in the weight-loss group and 4415 patients in the no-weight-loss group were balanced on 75 baseline characteristics. We defined weight loss as an admission-to-discharge weight loss of 1–30 kilograms, and we defined no weight loss as a weight gain or loss of < 1 kilogram. Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with weight loss were estimated. Results Patients had a mean age of 78 years, 57% were women, and 11% were African American. The median weight loss in the weight-loss group was 3.6 (interquartile range, 2.0–6.0) kilograms. HRs and 95% CIs for 30-day all-cause mortality, all-cause readmission and HF readmission associated with weight loss were 0.75 (0.63–0.90), 0.90 (0.83–0.99) and 0.83 (0.72–0.96), respectively. Respective 60-day HRs (95% CIs) were 0.80 (0.70–0.92), 0.91 (0.85–0.98) and 0.88 (0.79–0.98). These associations were attenuated and lost significance during 6 months of follow-up. Conclusions Among older patients hospitalized for decompensated HF, in-hospital weight loss was associated with a lower risk of mortality and hospital readmission. These findings suggest that in-hospital weight loss, a marker of successful diuresis and decongestion, is also a marker of improved clinical outcomes.
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