Clinical phenotypes according to diuretic combination in acute heart failure
Background: The treatment of congestion in heart failure (HF) is a challenge despite the therapeutic arsenal available. The aim of this study was to analyze different combinations of diuretics used to resolve congestion in patients admitted for decompensated HF and to define clinical profiles accord...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-09-01
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| Series: | Hellenic Journal of Cardiology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1109966623000568 |
| _version_ | 1797682523027800064 |
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| author | Raquel López-Vilella Pablo Jover Pastor Víctor Donoso Trenado Ignacio Sánchez-Lázaro Luis Martínez Dolz Luis Almenar Bonet |
| author_facet | Raquel López-Vilella Pablo Jover Pastor Víctor Donoso Trenado Ignacio Sánchez-Lázaro Luis Martínez Dolz Luis Almenar Bonet |
| author_sort | Raquel López-Vilella |
| collection | DOAJ |
| description | Background: The treatment of congestion in heart failure (HF) is a challenge despite the therapeutic arsenal available. The aim of this study was to analyze different combinations of diuretics used to resolve congestion in patients admitted for decompensated HF and to define clinical profiles according to these treatments. Methods: Single-center study of 1,559 patients admitted for decompensated HF was done between 2016 and 2020. Patients were grouped according to the diuretic combination that led to clinical stabilization and discharge from the hospital: (1) Loop diuretic. (2) Loop diuretic + distal tubule (antialdosterone ± thiazides). (3) Loop diuretic + distal + proximal tubule (acetazolamide ± SGLT2 inhibitor). (4) Loop diuretic + distal tubule + collecting duct (tolvaptan). (5) Loop diuretic + distal + proximal + collecting duct. Based on these diuretic combinations, profiles with clinical, analytical, and echocardiographic differences were established. Results: There were more previous hospitalizations in groups 4 and 5 (p = 0.001) with a predominance of pulmonary congestion in profiles 1 and 2 and systemic congestion in 3, 4, and 5. Creatinine and CA125 were higher in profiles 4 and 5 (p = 0.01 and p = 0.0001), with no differences in NT-proBNP. Profiles 4 and 5 had a higher proportion of dilatation and depression of right ventricular (p = 0.0001) and left ventricular (p = 0.003) function. Diuretic therapy-defined groups showed difference in clinical characteristics. Conclusions: The diuretic treatment used identifies five clinical profiles according to the degree of congestion, renal function, CA125, and right ventricular functionality. These profiles would guide the best diuretic treatment on admission. |
| first_indexed | 2024-03-12T00:00:57Z |
| format | Article |
| id | doaj.art-4e692f91369f4329b0715b02e281b4e1 |
| institution | Directory Open Access Journal |
| issn | 1109-9666 |
| language | English |
| last_indexed | 2024-03-12T00:00:57Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Hellenic Journal of Cardiology |
| spelling | doaj.art-4e692f91369f4329b0715b02e281b4e12023-09-18T04:29:45ZengElsevierHellenic Journal of Cardiology1109-96662023-09-017317Clinical phenotypes according to diuretic combination in acute heart failureRaquel López-Vilella0Pablo Jover Pastor1Víctor Donoso Trenado2Ignacio Sánchez-Lázaro3Luis Martínez Dolz4Luis Almenar Bonet5Heart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Corresponding author. Heart Failure and Transplantation Unit, La Fe University and Polytechnic Hospital, 106, Fernando Abril Martorell Av, PC 46026, Valencia, Spain.Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, SpainHeart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, SpainHeart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, SpainCardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, SpainHeart Failure and Transplantation Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, SpainBackground: The treatment of congestion in heart failure (HF) is a challenge despite the therapeutic arsenal available. The aim of this study was to analyze different combinations of diuretics used to resolve congestion in patients admitted for decompensated HF and to define clinical profiles according to these treatments. Methods: Single-center study of 1,559 patients admitted for decompensated HF was done between 2016 and 2020. Patients were grouped according to the diuretic combination that led to clinical stabilization and discharge from the hospital: (1) Loop diuretic. (2) Loop diuretic + distal tubule (antialdosterone ± thiazides). (3) Loop diuretic + distal + proximal tubule (acetazolamide ± SGLT2 inhibitor). (4) Loop diuretic + distal tubule + collecting duct (tolvaptan). (5) Loop diuretic + distal + proximal + collecting duct. Based on these diuretic combinations, profiles with clinical, analytical, and echocardiographic differences were established. Results: There were more previous hospitalizations in groups 4 and 5 (p = 0.001) with a predominance of pulmonary congestion in profiles 1 and 2 and systemic congestion in 3, 4, and 5. Creatinine and CA125 were higher in profiles 4 and 5 (p = 0.01 and p = 0.0001), with no differences in NT-proBNP. Profiles 4 and 5 had a higher proportion of dilatation and depression of right ventricular (p = 0.0001) and left ventricular (p = 0.003) function. Diuretic therapy-defined groups showed difference in clinical characteristics. Conclusions: The diuretic treatment used identifies five clinical profiles according to the degree of congestion, renal function, CA125, and right ventricular functionality. These profiles would guide the best diuretic treatment on admission.http://www.sciencedirect.com/science/article/pii/S1109966623000568heart failurecongestiondiureticsclinical profilestreatment |
| spellingShingle | Raquel López-Vilella Pablo Jover Pastor Víctor Donoso Trenado Ignacio Sánchez-Lázaro Luis Martínez Dolz Luis Almenar Bonet Clinical phenotypes according to diuretic combination in acute heart failure Hellenic Journal of Cardiology heart failure congestion diuretics clinical profiles treatment |
| title | Clinical phenotypes according to diuretic combination in acute heart failure |
| title_full | Clinical phenotypes according to diuretic combination in acute heart failure |
| title_fullStr | Clinical phenotypes according to diuretic combination in acute heart failure |
| title_full_unstemmed | Clinical phenotypes according to diuretic combination in acute heart failure |
| title_short | Clinical phenotypes according to diuretic combination in acute heart failure |
| title_sort | clinical phenotypes according to diuretic combination in acute heart failure |
| topic | heart failure congestion diuretics clinical profiles treatment |
| url | http://www.sciencedirect.com/science/article/pii/S1109966623000568 |
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