Prognostic Impact of Loop Diuretics in Patients With Chronic Heart Failure – Effects of Addition of Renin-Angiotensin-Aldosterone System Inhibitors and β-Blockers
Background:It remains to be elucidated whether addition of renin-angiotensin-aldosterone system (RAAS) inhibitors and/or β-blockers to loop diuretics has a beneficial prognostic impact on chronic heart failure (CHF) patients.Methods and Results:From the Chronic Heart failure Analysis and Registry in...
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| Veröffentlicht in: | Circulation Journal 2016/05/25, Vol.80(6), pp.1396-1403 |
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| creator | Miura, Masanobu Sugimura, Koichiro Sakata, Yasuhiko Miyata, Satoshi Tadaki, Soichiro Yamauchi, Takeshi Onose, Takeo Tsuji, Kanako Abe, Ruri Oikawa, Takuya Kasahara, Shintaro Nochioka, Kotaro Takahashi, Jun Shimokawa, Hiroaki on behalf of the CHART-2 Investigators |
| description | Background:It remains to be elucidated whether addition of renin-angiotensin-aldosterone system (RAAS) inhibitors and/or β-blockers to loop diuretics has a beneficial prognostic impact on chronic heart failure (CHF) patients.Methods and Results:From the Chronic Heart failure Analysis and Registry in the Tohoku district 2 (CHART-2) Study (n=10,219), we enrolled 4,134 consecutive patients with symptomatic stage C/D CHF (mean age, 69.3 years, 67.7% male). We constructed Cox models for composite of death, myocardial infarction, stroke and HF admission. On multivariate inverse probability of treatment weighted (IPTW) Cox modeling, loop diuretics use was associated with worse prognosis with hazard ratio (HR) 1.28 (P |
| doi_str_mv | 10.1253/circj.CJ-16-0216 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1792775016</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1792775016</sourcerecordid><originalsourceid>FETCH-LOGICAL-c494t-7a15d76784a41e42d5f45511fc1e01b313ad3f6d3428a46b5cde375d906e00e3</originalsourceid><addsrcrecordid>eNpFkc1uEzEURkcIRH9gzwp5yWaKPfbYM8sQGpoqEhVUYmk59p3EYcYOtrPoLu_AQ7Dvg_AQ8CJ4mtBu7E_WuedK_oriDcEXpKrpe22D3lxMr0vCS1wR_qw4JZSJkjUVfv6Qedk2jJ4UZzFuMK5aXLcvi5NKEIErjE-LXzfBr5yPyWo0H7ZKJ-Q7tPB-iz7aXYD8HpF16EYlCy5F9M2mNZqug3d54gpUSGimbJ_Rv_v9n_1PdNl1oDOYNRNjbLLejfkLOOvKiVtZn8DFMfcm74VsAvT1LqcBzd3aLm3yISLlDPp9X37ovf4OIb4qXnSqj_D6eJ8Xt7PL2-lVufj8aT6dLErNWpZKoUhtBBcNU4wAq0zdsbompNMEMFlSQpWhHTeUVY1ifFlrA1TUpsUcMAZ6Xrw7aLfB_9hBTHKwUUPfKwd-FyURbSVEjQnPKD6gOvgYA3RyG-ygwp0kWI7tyId25PRaEi7HdvLI26N9txzAPA78ryMDswOwiUmt4BHIv2x1D0djgyUfjyfzE7BWQYKj_wDrpaog</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1792775016</pqid></control><display><type>article</type><title>Prognostic Impact of Loop Diuretics in Patients With Chronic Heart Failure – Effects of Addition of Renin-Angiotensin-Aldosterone System Inhibitors and β-Blockers</title><source>J-STAGE Free</source><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Miura, Masanobu ; Sugimura, Koichiro ; Sakata, Yasuhiko ; Miyata, Satoshi ; Tadaki, Soichiro ; Yamauchi, Takeshi ; Onose, Takeo ; Tsuji, Kanako ; Abe, Ruri ; Oikawa, Takuya ; Kasahara, Shintaro ; Nochioka, Kotaro ; Takahashi, Jun ; Shimokawa, Hiroaki ; on behalf of the CHART-2 Investigators</creator><creatorcontrib>Miura, Masanobu ; Sugimura, Koichiro ; Sakata, Yasuhiko ; Miyata, Satoshi ; Tadaki, Soichiro ; Yamauchi, Takeshi ; Onose, Takeo ; Tsuji, Kanako ; Abe, Ruri ; Oikawa, Takuya ; Kasahara, Shintaro ; Nochioka, Kotaro ; Takahashi, Jun ; Shimokawa, Hiroaki ; on behalf of the CHART-2 Investigators ; CHART-2 Investigators ; on behalf of the CHART-2 Investigators</creatorcontrib><description>Background:It remains to be elucidated whether addition of renin-angiotensin-aldosterone system (RAAS) inhibitors and/or β-blockers to loop diuretics has a beneficial prognostic impact on chronic heart failure (CHF) patients.Methods and Results:From the Chronic Heart failure Analysis and Registry in the Tohoku district 2 (CHART-2) Study (n=10,219), we enrolled 4,134 consecutive patients with symptomatic stage C/D CHF (mean age, 69.3 years, 67.7% male). We constructed Cox models for composite of death, myocardial infarction, stroke and HF admission. On multivariate inverse probability of treatment weighted (IPTW) Cox modeling, loop diuretics use was associated with worse prognosis with hazard ratio (HR) 1.28 (P<0001). Furthermore, on IPTW multivariate Cox modeling for multiple treatments, both low-dose (<40 mg/day) and high-dose (≥40 mg/day) loop diuretics were associated with worse prognosis with HR 1.32 and 1.56, respectively (both P<0.001). Triple blockade with RAS inhibitor(s), mineral corticoid (aldosterone) receptor antagonist(s) (MRA), and β-blocker(s) was significantly associated with better prognosis in those on low-dose but not on high-dose loop diuretics.Conclusions:Chronic use of loop diuretics is significantly associated with worse prognosis in CHF patients in a dose-dependent manner, whereas the triple combination of RAAS inhibitor(s), MRA, and β-blocker(s) is associated with better prognosis when combined with low-dose loop diuretics. (Circ J 2016; 80: 1396–1403)</description><identifier>ISSN: 1346-9843</identifier><identifier>EISSN: 1347-4820</identifier><identifier>DOI: 10.1253/circj.CJ-16-0216</identifier><identifier>PMID: 27170200</identifier><language>eng</language><publisher>Japan: The Japanese Circulation Society</publisher><subject>Adrenergic beta-Antagonists - pharmacology ; Aged ; Chronic heart failure ; Diuretics - therapeutic use ; Dose-Response Relationship, Drug ; Female ; Heart Failure - drug therapy ; Humans ; Loop diuretics ; Male ; Mineralocorticoid Receptor Antagonists - pharmacology ; Prognosis ; Proportional Hazards Models ; Renin-Angiotensin System - drug effects ; Treatment</subject><ispartof>Circulation Journal, 2016/05/25, Vol.80(6), pp.1396-1403</ispartof><rights>2016 THE JAPANESE CIRCULATION SOCIETY</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c494t-7a15d76784a41e42d5f45511fc1e01b313ad3f6d3428a46b5cde375d906e00e3</citedby><cites>FETCH-LOGICAL-c494t-7a15d76784a41e42d5f45511fc1e01b313ad3f6d3428a46b5cde375d906e00e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1877,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27170200$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Miura, Masanobu</creatorcontrib><creatorcontrib>Sugimura, Koichiro</creatorcontrib><creatorcontrib>Sakata, Yasuhiko</creatorcontrib><creatorcontrib>Miyata, Satoshi</creatorcontrib><creatorcontrib>Tadaki, Soichiro</creatorcontrib><creatorcontrib>Yamauchi, Takeshi</creatorcontrib><creatorcontrib>Onose, Takeo</creatorcontrib><creatorcontrib>Tsuji, Kanako</creatorcontrib><creatorcontrib>Abe, Ruri</creatorcontrib><creatorcontrib>Oikawa, Takuya</creatorcontrib><creatorcontrib>Kasahara, Shintaro</creatorcontrib><creatorcontrib>Nochioka, Kotaro</creatorcontrib><creatorcontrib>Takahashi, Jun</creatorcontrib><creatorcontrib>Shimokawa, Hiroaki</creatorcontrib><creatorcontrib>on behalf of the CHART-2 Investigators</creatorcontrib><creatorcontrib>CHART-2 Investigators</creatorcontrib><creatorcontrib>on behalf of the CHART-2 Investigators</creatorcontrib><title>Prognostic Impact of Loop Diuretics in Patients With Chronic Heart Failure – Effects of Addition of Renin-Angiotensin-Aldosterone System Inhibitors and β-Blockers</title><title>Circulation Journal</title><addtitle>Circ J</addtitle><description>Background:It remains to be elucidated whether addition of renin-angiotensin-aldosterone system (RAAS) inhibitors and/or β-blockers to loop diuretics has a beneficial prognostic impact on chronic heart failure (CHF) patients.Methods and Results:From the Chronic Heart failure Analysis and Registry in the Tohoku district 2 (CHART-2) Study (n=10,219), we enrolled 4,134 consecutive patients with symptomatic stage C/D CHF (mean age, 69.3 years, 67.7% male). We constructed Cox models for composite of death, myocardial infarction, stroke and HF admission. On multivariate inverse probability of treatment weighted (IPTW) Cox modeling, loop diuretics use was associated with worse prognosis with hazard ratio (HR) 1.28 (P<0001). Furthermore, on IPTW multivariate Cox modeling for multiple treatments, both low-dose (<40 mg/day) and high-dose (≥40 mg/day) loop diuretics were associated with worse prognosis with HR 1.32 and 1.56, respectively (both P<0.001). Triple blockade with RAS inhibitor(s), mineral corticoid (aldosterone) receptor antagonist(s) (MRA), and β-blocker(s) was significantly associated with better prognosis in those on low-dose but not on high-dose loop diuretics.Conclusions:Chronic use of loop diuretics is significantly associated with worse prognosis in CHF patients in a dose-dependent manner, whereas the triple combination of RAAS inhibitor(s), MRA, and β-blocker(s) is associated with better prognosis when combined with low-dose loop diuretics. (Circ J 2016; 80: 1396–1403)</description><subject>Adrenergic beta-Antagonists - pharmacology</subject><subject>Aged</subject><subject>Chronic heart failure</subject><subject>Diuretics - therapeutic use</subject><subject>Dose-Response Relationship, Drug</subject><subject>Female</subject><subject>Heart Failure - drug therapy</subject><subject>Humans</subject><subject>Loop diuretics</subject><subject>Male</subject><subject>Mineralocorticoid Receptor Antagonists - pharmacology</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Renin-Angiotensin System - drug effects</subject><subject>Treatment</subject><issn>1346-9843</issn><issn>1347-4820</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkc1uEzEURkcIRH9gzwp5yWaKPfbYM8sQGpoqEhVUYmk59p3EYcYOtrPoLu_AQ7Dvg_AQ8CJ4mtBu7E_WuedK_oriDcEXpKrpe22D3lxMr0vCS1wR_qw4JZSJkjUVfv6Qedk2jJ4UZzFuMK5aXLcvi5NKEIErjE-LXzfBr5yPyWo0H7ZKJ-Q7tPB-iz7aXYD8HpF16EYlCy5F9M2mNZqug3d54gpUSGimbJ_Rv_v9n_1PdNl1oDOYNRNjbLLejfkLOOvKiVtZn8DFMfcm74VsAvT1LqcBzd3aLm3yISLlDPp9X37ovf4OIb4qXnSqj_D6eJ8Xt7PL2-lVufj8aT6dLErNWpZKoUhtBBcNU4wAq0zdsbompNMEMFlSQpWhHTeUVY1ifFlrA1TUpsUcMAZ6Xrw7aLfB_9hBTHKwUUPfKwd-FyURbSVEjQnPKD6gOvgYA3RyG-ygwp0kWI7tyId25PRaEi7HdvLI26N9txzAPA78ryMDswOwiUmt4BHIv2x1D0djgyUfjyfzE7BWQYKj_wDrpaog</recordid><startdate>20160525</startdate><enddate>20160525</enddate><creator>Miura, Masanobu</creator><creator>Sugimura, Koichiro</creator><creator>Sakata, Yasuhiko</creator><creator>Miyata, Satoshi</creator><creator>Tadaki, Soichiro</creator><creator>Yamauchi, Takeshi</creator><creator>Onose, Takeo</creator><creator>Tsuji, Kanako</creator><creator>Abe, Ruri</creator><creator>Oikawa, Takuya</creator><creator>Kasahara, Shintaro</creator><creator>Nochioka, Kotaro</creator><creator>Takahashi, Jun</creator><creator>Shimokawa, Hiroaki</creator><creator>on behalf of the CHART-2 Investigators</creator><general>The Japanese Circulation Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160525</creationdate><title>Prognostic Impact of Loop Diuretics in Patients With Chronic Heart Failure – Effects of Addition of Renin-Angiotensin-Aldosterone System Inhibitors and β-Blockers</title><author>Miura, Masanobu ; Sugimura, Koichiro ; Sakata, Yasuhiko ; Miyata, Satoshi ; Tadaki, Soichiro ; Yamauchi, Takeshi ; Onose, Takeo ; Tsuji, Kanako ; Abe, Ruri ; Oikawa, Takuya ; Kasahara, Shintaro ; Nochioka, Kotaro ; Takahashi, Jun ; Shimokawa, Hiroaki ; on behalf of the CHART-2 Investigators</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c494t-7a15d76784a41e42d5f45511fc1e01b313ad3f6d3428a46b5cde375d906e00e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adrenergic beta-Antagonists - pharmacology</topic><topic>Aged</topic><topic>Chronic heart failure</topic><topic>Diuretics - therapeutic use</topic><topic>Dose-Response Relationship, Drug</topic><topic>Female</topic><topic>Heart Failure - drug therapy</topic><topic>Humans</topic><topic>Loop diuretics</topic><topic>Male</topic><topic>Mineralocorticoid Receptor Antagonists - pharmacology</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Renin-Angiotensin System - drug effects</topic><topic>Treatment</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Miura, Masanobu</creatorcontrib><creatorcontrib>Sugimura, Koichiro</creatorcontrib><creatorcontrib>Sakata, Yasuhiko</creatorcontrib><creatorcontrib>Miyata, Satoshi</creatorcontrib><creatorcontrib>Tadaki, Soichiro</creatorcontrib><creatorcontrib>Yamauchi, Takeshi</creatorcontrib><creatorcontrib>Onose, Takeo</creatorcontrib><creatorcontrib>Tsuji, Kanako</creatorcontrib><creatorcontrib>Abe, Ruri</creatorcontrib><creatorcontrib>Oikawa, Takuya</creatorcontrib><creatorcontrib>Kasahara, Shintaro</creatorcontrib><creatorcontrib>Nochioka, Kotaro</creatorcontrib><creatorcontrib>Takahashi, Jun</creatorcontrib><creatorcontrib>Shimokawa, Hiroaki</creatorcontrib><creatorcontrib>on behalf of the CHART-2 Investigators</creatorcontrib><creatorcontrib>CHART-2 Investigators</creatorcontrib><creatorcontrib>on behalf of the CHART-2 Investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation Journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Miura, Masanobu</au><au>Sugimura, Koichiro</au><au>Sakata, Yasuhiko</au><au>Miyata, Satoshi</au><au>Tadaki, Soichiro</au><au>Yamauchi, Takeshi</au><au>Onose, Takeo</au><au>Tsuji, Kanako</au><au>Abe, Ruri</au><au>Oikawa, Takuya</au><au>Kasahara, Shintaro</au><au>Nochioka, Kotaro</au><au>Takahashi, Jun</au><au>Shimokawa, Hiroaki</au><au>on behalf of the CHART-2 Investigators</au><aucorp>CHART-2 Investigators</aucorp><aucorp>on behalf of the CHART-2 Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic Impact of Loop Diuretics in Patients With Chronic Heart Failure – Effects of Addition of Renin-Angiotensin-Aldosterone System Inhibitors and β-Blockers</atitle><jtitle>Circulation Journal</jtitle><addtitle>Circ J</addtitle><date>2016-05-25</date><risdate>2016</risdate><volume>80</volume><issue>6</issue><spage>1396</spage><epage>1403</epage><pages>1396-1403</pages><issn>1346-9843</issn><eissn>1347-4820</eissn><abstract>Background:It remains to be elucidated whether addition of renin-angiotensin-aldosterone system (RAAS) inhibitors and/or β-blockers to loop diuretics has a beneficial prognostic impact on chronic heart failure (CHF) patients.Methods and Results:From the Chronic Heart failure Analysis and Registry in the Tohoku district 2 (CHART-2) Study (n=10,219), we enrolled 4,134 consecutive patients with symptomatic stage C/D CHF (mean age, 69.3 years, 67.7% male). We constructed Cox models for composite of death, myocardial infarction, stroke and HF admission. On multivariate inverse probability of treatment weighted (IPTW) Cox modeling, loop diuretics use was associated with worse prognosis with hazard ratio (HR) 1.28 (P<0001). Furthermore, on IPTW multivariate Cox modeling for multiple treatments, both low-dose (<40 mg/day) and high-dose (≥40 mg/day) loop diuretics were associated with worse prognosis with HR 1.32 and 1.56, respectively (both P<0.001). Triple blockade with RAS inhibitor(s), mineral corticoid (aldosterone) receptor antagonist(s) (MRA), and β-blocker(s) was significantly associated with better prognosis in those on low-dose but not on high-dose loop diuretics.Conclusions:Chronic use of loop diuretics is significantly associated with worse prognosis in CHF patients in a dose-dependent manner, whereas the triple combination of RAAS inhibitor(s), MRA, and β-blocker(s) is associated with better prognosis when combined with low-dose loop diuretics. (Circ J 2016; 80: 1396–1403)</abstract><cop>Japan</cop><pub>The Japanese Circulation Society</pub><pmid>27170200</pmid><doi>10.1253/circj.CJ-16-0216</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adrenergic beta-Antagonists - pharmacology Aged Chronic heart failure Diuretics - therapeutic use Dose-Response Relationship, Drug Female Heart Failure - drug therapy Humans Loop diuretics Male Mineralocorticoid Receptor Antagonists - pharmacology Prognosis Proportional Hazards Models Renin-Angiotensin System - drug effects Treatment |
| title | Prognostic Impact of Loop Diuretics in Patients With Chronic Heart Failure – Effects of Addition of Renin-Angiotensin-Aldosterone System Inhibitors and β-Blockers |
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