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Association of diuretic treatment at hospital discharge in patients with heart failure with all-cause short- and long-term mortality: A propensity score-matched analysis from SwedeHF.

https://arctichealth.org/en/permalink/ahliterature295612
Source
Int J Cardiol. 2018 04 15; 257:118-124
Publication Type
Comparative Study
Journal Article
Date
04-15-2018
Author
Pär Parén
Ulf Dahlström
Magnus Edner
Georgios Lappas
Annika Rosengren
Maria Schaufelberger
Author Affiliation
Department of Internal Medicine, Sahlgrenska University Hospital/Mölndal, Mölndal, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden. Electronic address: par.paren@vgregion.se.
Source
Int J Cardiol. 2018 04 15; 257:118-124
Date
04-15-2018
Language
English
Publication Type
Comparative Study
Journal Article
Keywords
Aged
Aged, 80 and over
Cause of Death - trends
Cohort Studies
Diuretics - therapeutic use
Female
Follow-Up Studies
Heart Failure - drug therapy - mortality
Humans
Male
Middle Aged
Mortality - trends
Patient Discharge - trends
Propensity Score
Registries
Sodium Potassium Chloride Symporter Inhibitors - therapeutic use
Sweden - epidemiology
Treatment Outcome
Abstract
Diuretics are recommended for treating congestive symptoms in heart failure (HF). The short- and long-term prognostic effects of diuretic treatment at hospital discharge have not been studied in randomized clinical trials or in a Western world population. We aimed to determine the association of diuretic treatment at discharge with the risk of short-and long-term all-cause mortality in real-life patients in Sweden with HF irrespective of EF.
From a Swedish nationwide HF register 26,218 patients discharged from hospital were included in the present study. A total of 87% of patients were treated with and 13% were not treated with diuretics at hospital discharge. In a 1:1 propensity score-matched cohort of 6564 patients, the association of diuretic treatment at hospital discharge with the risk of 90-day all-cause mortality was neutral (HR 0.89, 95% CI 0.74-1.07, p=0.21) whereas the risk of long-term all-cause mortality (median follow-up: 2.85years) was increased (HR 1.15, 95% CI 1.06-1.24, p
PubMed ID
29506681 View in PubMed
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The benefits of using a heart failure management programme in Swedish primary healthcare.

https://arctichealth.org/en/permalink/ahliterature119362
Source
Eur J Heart Fail. 2013 Feb;15(2):228-36
Publication Type
Article
Date
Feb-2013
Author
Björn Agvall
Urban Alehagen
Ulf Dahlström
Author Affiliation
County Council of Östergötland, Local Health Care Services in Central Östergötland, Primary Health Care Centres, Linköping University, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping, Sweden. Bjorn.Agvall@lio.se
Source
Eur J Heart Fail. 2013 Feb;15(2):228-36
Date
Feb-2013
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Aged
Aged, 80 and over
Angiotensin II Type 1 Receptor Blockers - therapeutic use
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Disease Management
Diuretics - therapeutic use
Female
Follow-Up Studies
Furosemide - therapeutic use
General practice
Guideline Adherence
Heart Failure, Systolic - diagnosis - drug therapy - mortality - physiopathology
Humans
Male
Natriuretic Peptide, Brain - blood
Nurse Clinicians
Patient care team
Patient Education as Topic
Patient Readmission - statistics & numerical data
Peptide Fragments - blood
Primary Health Care
Prospective Studies
Stroke Volume - drug effects - physiology
Sweden
Abstract
Heart failure (HF) is a common condition with which high mortality, morbidity, and poor quality of life are associated. It has previously been shown that use of HF management programmes (HFMPs) in HF clinics can be beneficial. The purpose of this study was to evaluate if the use of HFMPs also has beneficial effects on HF patients in primary healthcare (PHC).
This is a randomized, prospective, open-label study including 160 patients from five PHC centres with systolic HF and a mean age of 75 years (standard deviation 7.8). In the intervention group, an intensive follow-up was performed by HF nurses and physicians providing information and education about HF and the optimization of HF treatment according to recognized guidelines. There was a significant improvement of composite endpoints in the intervention group. Significantly more patients with reduced N-terminal pro brain natriuretic peptide (P = 0.012), improved cardiac function (P = 0.03), fewer healthcare contacts (P = 0.04), and fewer emergency room visits and admittances (P = 0.0002 and P = 0.03, respectively) could be seen in the intervention group when compared with the control group.
The use of a HFMP in a PHC setting was found to have beneficial effects in terms of reducing the number of healthcare contacts and hospital admissions, and improving cardiac function in patients with systolic HF, even if the result should be interpreted with caution. It can therefore be recommended that HFMPs should be used in PHC.
PubMed ID
23109650 View in PubMed
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