| アブストラクト | BACKGROUND: Loop diuretics are commonly prescribed in primary care. We explored HF assessment, diagnosis, and outcomes following a loop diuretic prescription. METHODS & RESULTS: The Clinical Practice Research Datalink Gold database linked to Hospital Episode Statistics (HES) and Office for National Statistics mortality registry in the UK was used to identify patients prescribed loop diuretics, and subsequent HF diagnoses. HF assessment was defined as natriuretic peptide (NP) testing, echocardiography, or out-patient cardiology referral. NP thresholds recommended by National Institute of Health and Care Excellence (NICE) and European Society of Cardiology (ESC) were explored. The primary endpoint was HF events (presentation to primary care with symptoms of HF, HF hospitalisation, or all-cause mortality). A total of 71,847 patients were prescribed a loop diuretic without a diagnosis of HF; 9876 (14 %) underwent HF assessment and 1483 (15 %) were diagnosed with HF within five years. Of those who were assessed, 5316 (54 %) had NP testing: 1937 (36 %) and 3200 (60 %) patients had NP concentrations above the NICE and ESC referral thresholds, respectively. Of those above the NICE threshold, 701 (36 %) were referred to cardiology. Compared to those who were not referred, there was a lower rate of all-cause mortality (47 % vs. 57 %; P < 0.001; hazard ratio = 0.87 (95 % confidence interval 0.76-0.99); P = 0.04). CONCLUSIONS: One in seven patients without HF prescribed a loop diuretic undergo HF assessment, one in six of those assessed had a HF diagnosis. Specialist referral in patients with raised NP was associated with a lower risk of death. |
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| 投稿者 | Cuthbert, J J; Lomax, S; Soyiri, I; Luo, E; Turgoose, J; Cohen, J; Fuat, A; Taylor, C J; Clark, A L |
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| 組織名 | Department of Cardiology, Centre for Clinical Sciences, Hull York Medical School,;University of Hull, Cottingham Road, Kingston-Upon-Hull HU6 7RX, United Kingdom;;Department of Cardiology, Hull University Teaching Hospitals Trust, Castle Hill;Hospital, Cottingham, Kingston-Upon-Hull HU16 5JQ, United Kingdom. Electronic;address: Joe.cuthbert@hyms.ac.uk.;Greengates Medical Group, Cottingham Medical Centre, Cottingham, United Kingdom.;Institute for Clinical and Applied Health Research, Hull York Medical School,;University of Hull, Kingston-Upon-Hull, United Kingdom.;Hospital, Cottingham, Kingston-Upon-Hull HU16 5JQ, United Kingdom.;Hull Health Trials Unit, Hull York Medical School, University of Hull, Cottingham;Road, Kingston-Upon-Hull HU6 7RX, United Kingdom.;Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust;and School of Medicine, Pharmacy and Health, Durham University, Durham, United;Kingdom.;Department of Applied Health Sciences, School of Health Sciences, College of;Medicine and Health, University of Birmingham, B15 2TT. |
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