000			04025nam a22005057a 4500
008			200902s20202020 xxu||||| |||| 00| 0 eng d
022			_a0735-1097
024			_a10.1016/j.jacc.2020.06.022 [doi]
024			_aS0735-1097(20)35642-4 [pii]
040			_aOvid MEDLINE(R)
099			_a32762901
245			_aLoop Diuretic Prescription and 30-Day Outcomes in Older Patients With Heart Failure.
251			_aJournal of the American College of Cardiology. 76(6):669-679, 2020 08 11.
252			_aJ Am Coll Cardiol. 76(6):669-679, 2020 08 11.
252			_zJ Am Coll Cardiol. 76(6):669-679, 2020 Aug 11.
253			_aJournal of the American College of Cardiology
260			_c2020
260			_fFY2021
265			_sppublish
265			_sppublish
266			_d2020-09-02
268			_aJournal of the American College of Cardiology. 76(6):669-679, 2020 Aug 11.
520			_aBACKGROUND: Heart failure (HF) is a major source of morbidity and mortality. Fluid retention and shortness of breath are its cardinal manifestations for which loop diuretics are used. Although their usefulness is well accepted, less is known about their role in improving clinical outcomes.
520			_aCONCLUSIONS: Hospitalized older patients not taking diuretics prior to hospitalization for HF decompensation who received a discharge prescription for loop diuretics had significantly better 30-day clinical outcomes than those not discharged on loop diuretics. These findings provide new information about short-term clinical benefits associated with loop diuretic use in HF. Copyright Published by Elsevier Inc.
520			_aMETHODS: Of the 25,345 older patients hospitalized for HF in the Medicare-linked OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) registry, 9,866 (39%) received no pre-admission diuretics. The study excluded 1,083 patients receiving dialysis and 847 discharged on thiazide diuretics. Of the remaining 7,936 patients, 5,568 (70%) were prescribed loop diuretics at discharge. Using propensity scores for receipt of loop diuretics estimated for each of the 7,936 patients, a matched cohort of 2,191 pairs of patients was assembled balanced on 74 baseline characteristics. Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes were estimated in the matched cohort.
520			_aOBJECTIVES: The purpose of this study was to determine the relationship between loop diuretics and clinical outcomes in patients with HF.
520			_aRESULTS: Matched patients (n = 4,382) had a mean age of 78 years, 54% were women, and 11% were African American. The 30-day all-cause mortality occurred in 4.9% (107 of 2,191) and 6.6% (144 of 2,191) of patients in the loop diuretic and no loop diuretic groups, respectively (HR when the use of loop diuretics was compared with nonuse: 0.73; 95% CI: 0.57 to 0.94; p = 0.016). Patients in the loop diuretic group had a significantly lower risk of 30-day HF readmission (HR: 0.79; 95% CI: 0.63 to 0.99; p = 0.037) but not of 30-day all-cause readmission (HR: 0.89; 95% CI: 0.79 to 1.01; p = 0.081). None of the associations was statistically significant during 60 days of follow-up.
546			_aEnglish
650			_a*Heart Failure/dt [Drug Therapy]
650			_a*Sodium Potassium Chloride Symporter Inhibitors/tu [Therapeutic Use]
650			_aAged
650			_aAged, 80 and over
650			_aCohort Studies
650			_aFemale
650			_aHumans
650			_aMale
650			_aTime Factors
650			_aTreatment Outcome
651			_aMedStar Heart & Vascular Institute
657			_aJournal Article
700			_aLam, Phillip H
790			_aAhmed A, Allman RM, Arundel C, Deedwania P, Faselis C, Filippatos G, Fonarow GC, Gottlieb SS, Lam PH, Morgan CJ, Nguyen T, Patel S, Sheriff HM, Wopperer S, Zeng Q, Zile MR
856			_uhttps://dx.doi.org/10.1016/j.jacc.2020.06.022 _zhttps://dx.doi.org/10.1016/j.jacc.2020.06.022
942			_cART _dArticle
999			_c5495 _d5495