Abstract
Background One of the strategies for overcoming diuretic resistance among heart failure (HF) patients is adding thiazide-type diuretics. The main aim of this article is to compare the adverse clinical outcomes, including death and re-hospitalization, among individuals suffering from severe acute decompensated HF (ADHF) that consumed furosemide or furosemide plus metolazone. Methods This retrospective cohort study was done in the context of the Persian registry of cardiovascular disease (PROVE) from September 2017 to September 2018. One thousand and four hundred thirty-eight individuals (furosemide: 972 and furosemide plus metolazone: 466) with the final diagnosis of severe ADHF (left ventricular ejection fraction < 30%) were selected and followed for 10.3 ± 7.8 months. The association between two groups, as mentioned above, with the incidence of death and re-admission, was evaluated with different models. Results The mean age of the study population was 68.19 ± 12.98 years. There was no significant relation in terms of death or re-hospitalization between patients with different diuretic regimens. After adjustment of potential confounders, we found that adding metolazone as an adjuvant HF therapy was not independently associated with death or re-hospitalization (hazard ratio (HR): 0.78,95% confidence interval (CI) = 0.59–1.03, P = 0.085, and odds ratio (OR): 0.80, 95% CI: 0.60–1.07, P = 0.135, respectively). Conclusion Our findings revealed that adding metolazone in patients with furosemide resistance is not associated with higher morbidity and mortality. Therefore, usage of these two therapeutic agents could be a helpful strategy for severe HF patients.
Highlights
Increasing the prevalence of previously proved cardiovascular risk factors among developed and developing nations leads to categorizing cardiovascular diseases (CVDs) as the leading cause of mortality [1,2,3,4,5,6]
Cox regression hazard ratio (HR) and odds ratio (OR) models were used to evaluate the relation of death and re-hospitalization based on the categories of diuretic agent usage, respectively, with univariate and multivariate models adjusted for age, sex, body mass index (BMI), ischemic heart disease, diabetes mellitus, hypertension, stroke, kidney diseases, chronic obstructive pulmonary disease, smoking, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rates, hemoglobin, sodium, potassium, blood urea nitrogen (BUN), Cr, and discharged drug consumption. e multivariate model was used to assess the sole effect of diuretic agent groups on death and re-hospitalization
Our principle aim of the current study was to evaluate the probable occurrence of death and re-hospitalization among Iranian acute decompensated heart failure (HF) (ADHF) patients who consumed either furosemide or furosemide plus metolazone
Summary
Increasing the prevalence of previously proved cardiovascular risk factors among developed and developing nations leads to categorizing cardiovascular diseases (CVDs) as the leading cause of mortality [1,2,3,4,5,6]. As well as therapeutic methods, have been suggested till this chronic disorder has been associated with 31.7% mortality. It causes $ 108 billion dollars for its annual management cost [7,8,9,10]. Despite no approved superiority in terms of survival rate with loop diuretics, these agents remain the Critical Care Research and Practice cornerstone part of HF treatment in a way that this drug had been prescribed for 86–97% of individuals hospitalized for ADHF [11, 12]. Diuretic resistance has been proved to be associated with higher mortality, long-term complication incidence in the presence of metolazone as adjuvant therapy is less frequently investigated [18]. Is article sought to assess the mortality and re-hospitalization rates among patients suffering from ADHF with/ without metolazone add-on therapy
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