Safety of diuretic administration during the early management of dyspnea patients who are not finally diagnosed with acute heart failure
Por:
Takagi, K, Miro, O, Gayat, E, Llorens, P, Wussler, D, Cerlinskaite, K, Msolli, M, Kavoliuniene, A, Sekma, A, Celutkiene, J, Nouira, S, Gil, V, Martinez-Nadal, G, Breidthardt, T, Kozhuharov, N, Martin, J, Muller, C and Mebazaa, A
Publicada:
1 dic 2020
Resumen:
Objectives
Investigating whether it is safe or not to administrate diuretics to patients arriving at emergency departments in a stage of acute dyspnea but without a final diagnosis of acute heart failure.
Methods
We analyzed an unselected multinational sample of patients with dyspnea without a final diagnosis of acute heart failure from Global Research on Acute Conditions Team (France, Lithuania, Tunisia) and Basics in Acute Shortness of Breath Evaluation (Switzerland) registries. Thirty-day all-cause mortality and 30-day postdischarge all-cause readmission rate of treated patients with diuretics at emergency departments were compared with untreated patients by unadjusted and adjusted hazard and odds ratios. Interaction and stratified analyses were performed.
Results
We included 2505 patients. Among them, 365 (14.6%) received diuretics in emergency departments. Thirty-day mortality was 4.5% (treated/untreated = 5.2%/4.3%, hazard ratio: 1.22; 95% confidence interval, 0.75-2.00) and 30-day readmission rate was 11.3% (14.7%/10.8%, odds ratio: 1.41; 95% confidence interval, 0.95-2.11). After adjustment, no differences were found between two groups in mortality (hazard ratio: 0.86; 95% confidence interval, 0.51-1.44) and readmission (odds ratio: 1.15; 95% confidence interval, 0.72-1.82). Age significantly interacted with the use of diuretics and readmission (P = 0.03), with better prognosis when used in patients >80 years (odds ratio: 0.27; 95% confidence interval, 0.07-1.03) than in patients <= 80 years (odds ratio: 1.56; 95% confidence interval, 0.94-2.63).
Conclusions
Diuretic administration to patients presenting to emergency departments with dyspnea while they were undiagnosed and in whom acute heart failure was finally excluded was not associated with 30-day all-cause mortality and 30-day postdischarge all-cause readmission rate.
Filiaciones:
Takagi, K:
INSERM UMRS 942, Paris, France
Nippon Med Sch, Musashi Kosugi Hosp, Cardiol & Intens Care Unit, Kawasaki, Kanagawa, Japan
Miro, O:
Univ Barcelona, Hosp Clin, Emergency Dept, Barcelona, Spain
Univ Barcelona, Inst Invest Biomed August Pi i Sunyer IDIBAPS, Barcelona, Spain
GREAT Global Res Acute Condit Team Network, St Louis, France
Gayat, E:
INSERM UMRS 942, Paris, France
GREAT Global Res Acute Condit Team Network, St Louis, France
AP HP, Dept Anaesthesiol & Crit Care Med, St Louis, France
Lariboisiere Univ Hosp, Paris, France
:
Hosp Gen Alicante, Emergency Dept, Short Stay Unit, Alicante, Spain
Hosp Gen Alicante, Home Hospitalizat, Alicante, Spain
Wussler, D:
Univ Hosp Basel, Cardiol Dept, Basel, Switzerland
Cerlinskaite, K:
Vilnius Univ, Med Fac, Inst Clin Med, Clin Cardiac & Vasc Dis, Vilnius, Lithuania
Vilnius Univ Hosp, Santaros Klin, Ctr Cardiol & Angiol, Vilnius, Lithuania
Msolli, M:
Fattouma Bourguiba Univ Hosp, Emergency Dept, Monastir, Tunisia
Univ Monastir, Res Lab LR12SP18, Monastir, Tunisia
Kavoliuniene, A:
Lithuanian Univ Hlth Sci, Kaunas, Lithuania
Sekma, A:
Fattouma Bourguiba Univ Hosp, Emergency Dept, Monastir, Tunisia
Univ Monastir, Res Lab LR12SP18, Monastir, Tunisia
Celutkiene, J:
Vilnius Univ, Med Fac, Inst Clin Med, Clin Cardiac & Vasc Dis, Vilnius, Lithuania
Vilnius Univ Hosp, Santaros Klin, Ctr Cardiol & Angiol, Vilnius, Lithuania
Nouira, S:
Fattouma Bourguiba Univ Hosp, Emergency Dept, Monastir, Tunisia
Univ Monastir, Res Lab LR12SP18, Monastir, Tunisia
Gil, V:
Univ Barcelona, Hosp Clin, Emergency Dept, Barcelona, Spain
Univ Barcelona, Inst Invest Biomed August Pi i Sunyer IDIBAPS, Barcelona, Spain
Martinez-Nadal, G:
Univ Barcelona, Hosp Clin, Emergency Dept, Barcelona, Spain
Univ Barcelona, Inst Invest Biomed August Pi i Sunyer IDIBAPS, Barcelona, Spain
Breidthardt, T:
Univ Hosp Basel, Cardiol Dept, Basel, Switzerland
Kozhuharov, N:
Univ Hosp Basel, Cardiol Dept, Basel, Switzerland
Martin, J:
Univ Hosp Basel, Cardiol Dept, Basel, Switzerland
Muller, C:
GREAT Global Res Acute Condit Team Network, St Louis, France
Univ Hosp Basel, Cardiol Dept, Basel, Switzerland
Mebazaa, A:
INSERM UMRS 942, Paris, France
GREAT Global Res Acute Condit Team Network, St Louis, France
AP HP, Dept Anaesthesiol & Crit Care Med, St Louis, France
Lariboisiere Univ Hosp, Paris, France
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