Effects of high-dose furosemide and small-volume hypertonic saline solution infusion in comparison with a high dose of furosemide as a bolus, in refractory congestive heart failure

BACKGROUND: Diuretics, have been accepted as first-line treatment in refractory heart failure, but a lack of response is a frequent event. A randomised single blind study was performed to evaluate the effects of the combination of high-dose furosemide and small-volume hypertonic saline solution (HSS) infusion in the treatment of refractory NYHA class IV congestive heart failure (CHF). MATERIALS AND METHODS: Sixty patients (21 F/39 M) with refractory CHF (NYHA class IV) of different etiologies, unresponsive to high oral doses of furosemide, ACE-inhibitors, digitalis, and nitrates, aged 65-90 years, were enrolled. They had to have an ejection fraction (EF) <35%, serum creatinine <2 mg/dl, BUN 相似文献   

高渗盐水合并大剂量呋噻米治疗老年难治性心力衰竭疗效的观察

目的观察高渗盐水(hypertonic saline solution,HSS)合并大剂量呋噻米治疗老年难治性慢性心力衰竭的短期疗效并探讨其作用机制。方法符合入选条件的老年心力衰竭患者87例,随机(单盲)分为两组。治疗组(Ⅰ组)47例在常规口服血管紧张素转换酶(ACE)抑制剂、洋地黄、β受体阻滞剂等治疗的基础上加用HSS并大剂量呋噻米静脉滴注30 min,对照组(Ⅱ组)40例在常规口服ACE抑制剂、洋地黄、β受体阻滞剂等治疗的基础上只静脉应用大剂量呋噻米。Ⅰ组患者每天钠摄入量120 mmol,Ⅱ组患者每天80 mmol,两组每天液体摄入量均为1 000 ml,观察两组患者临床疗效及短期随访效果。结果所有患者临床症状均有所改变;两组患者每天尿量及尿钠均明显增加,Ⅰ组更明显(P<0.05);Ⅰ组患者血钠增高,而Ⅱ组患者血钠降低(P<0.05),出院时Ⅰ组患者血钠明显高于Ⅱ组患者(P<0.05);两组患者血钾均降低(P<0.05);体重均减少(P<0.05),Ⅰ组更明显(P<0.05);Ⅰ组患者住院时间及再住院率明显降低(P<0.05);而两组患者左心室射血分数无明显增加(P>0.05)。结论HSS合并大剂量呋噻米治疗老年难治性慢性心力衰竭安全,可靠,耐受性好,短期疗效明显,副作用少。     

呋塞米联合小剂量多巴胺间歇静脉泵入治疗终末期心力衰竭合并利尿剂抵抗

目的观察比较间歇微量泵静脉泵入呋塞米和多巴胺与分次静脉推注呋塞米治疗终末期心衰伴利尿剂抵抗患者的疗效。方法将56例利尿剂抵抗性心力衰竭患者随机分为两组,对照组28例患者在进行常规抗心力衰竭治疗基础上,单纯分次静脉推注呋塞米治疗;观察组28例患者在常规抗心力衰竭治疗的基础上同时给予呋塞米和多巴胺间歇静脉泵入治疗。两组患者均治疗5 d。观察治疗前后两组患者在心功能分级（NYHA）、心功能指标、肾功能、尿量和体重等方面的变化。结果与对照组比较,观察组患者心功能分级（NYHA）明显改善,LVEF增加,6 min步行试验距离延长,尿量明显增加（P均〈0.05）。结论对终末期心衰伴利尿剂抵抗的患者,间歇静脉泵入呋塞米和多巴胺治疗的疗效优于单纯静脉推注呋塞米治疗。     

Prediction models for heart failure in the community: A systematic review and meta-analysis

Aims

Multivariable prediction models can be used to estimate risk of incident heart failure (HF) in the general population. A systematic review and meta-analysis was performed to determine the performance of models.

Methods and results

From inception to 3 November 2022 MEDLINE and EMBASE databases were searched for studies of multivariable models derived, validated and/or augmented for HF prediction in community-based cohorts. Discrimination measures for models with c-statistic data from ≥3 cohorts were pooled by Bayesian meta-analysis, with heterogeneity assessed through a 95% prediction interval (PI). Risk of bias was assessed using PROBAST. We included 36 studies with 59 prediction models. In meta-analysis, the Atherosclerosis Risk in Communities (ARIC) risk score (summary c-statistic 0.802, 95% confidence interval [CI] 0.707–0.883), GRaph-based Attention Model (GRAM; 0.791, 95% CI 0.677–0.885), Pooled Cohort equations to Prevent Heart Failure (PCP-HF) white men model (0.820, 95% CI 0.792–0.843), PCP-HF white women model (0.852, 95% CI 0.804–0.895), and REverse Time AttentIoN model (RETAIN; 0.839, 95% CI 0.748–0.916) had a statistically significant 95% PI and excellent discrimination performance. The ARIC risk score and PCP-HF models had significant summary discrimination among cohorts with a uniform prediction window. 77% of model results were at high risk of bias, certainty of evidence was low, and no model had a clinical impact study.

Conclusions

Prediction models for estimating risk of incident HF in the community demonstrate excellent discrimination performance. Their usefulness remains uncertain due to high risk of bias, low certainty of evidence, and absence of clinical effectiveness research.     

Ultrafiltration for patients with acute decompensated heart failure: A systematic review and meta-analysis

Background:Ultrafiltration plays an indispensable role in relieving congestion and fluid retention in patients with acute decompensated heart failure (ADHF) in recent years. So far, there is no consistent agreement about whether early ultrafiltration (UF) is a first-line treatment for patients with ADHF. We, therefore, conducted a meta-analysis to assess the efficacy and safety of UF.Methods:PubMed, Embase, and Cochrane Library databases were searched for randomized controlled trials (RCTs) that compared UF with diuretics in patients with ADHF and included our interested outcomes. The primary outcomes are heart failure rehospitalization, all-cause rehospitalization, and mortality. The second outcomes are fluid loss, weight loss, and adverse events. RevMan Version 5.4.1 was used to analyze the data of included studies.Results:A total of 12 studies with 1197 patients were included. Our results showed a reduction in heart failure rehospitalization (risk ratio [RR] 0.67, 95% confidence interval [CI]: 0.52–0.87, P = .003) and all-cause rehospitalization (RR 0.62, 95% CI: 0.42–0.92; P = .02), an increase in fluid loss (1.47 L, 95% CI: 0.95–1.99 L, P < .001) and weight loss (1.65 kg, 95% CI: 0.90–2.41 kg; P < .001). There was no difference in mortality (RR 1.09, 95% CI: 0.78–1.51; P = .62). There were inconsistent agreements about which group have more total adverse events. Subgroup analysis showed that UF with larger mean fluid-remove rate (≥200 mL/h) could significantly remove more fluid, lose more weight, and decrease heart failure rehospitalization. Less weight loss for patients with ADHF may correlated to higher percent of ischemic etiology (ischemic etiology ≥50%).Conclusion:Although UF is more effective in removing fluid than diuretics and decrease rehospitalization of heart failure and all causes, there is not enough evidence to prove that UF is superior because of adverse events and mortality in the UF group. The mean fluid-removal rates should be set to ≥200 mL/h. Patient with different etiology may have different effects when treated with UF and it is a weak conclusion.Trial registration: The systematic review was registered with the International Prospective Registry of Systematic Reviews. (https://www.crd.york.ac.uk/prospero/, registration number CRD42021245049).     

Safety and efficacy of omecamtiv mecarbil for heart failure: A systematic review and meta-analysis

AimTo assess the safety and efficacy of omecamtiv mecarbil compared with placebo in heart failure (HF) patients.MethodsWe searched PubMed, Web of Science, Cochrane Library, and SCOPUS until August 15th, 2021. We included all randomized controlled studies comparing omecamtiv mecarbil with placebo in heart failure patients. The meta-analysis was carried out using Rev Man software V5.4.ResultsA total of eight studies were included in our systematic review. Pooled analysis showed that omecamtiv mecarbil is not associated with increased incidence of death, any adverse events, hypotension, heart failure, ventricular tachyarrhythmia, dyspnea, dizziness, and serious adverse events. Regarding the efficacy, omecamtiv mecarbil significantly reduced heart rate with some studies demonstrating its significant improvement in left ventricular ejection fraction and systolic function.Conclusion: Omecamtiv mecarbil is a well-tolerated drug in heart failure patients. The limited data regarding the efficacy suggested that it may improve ejection fraction and systolic function.     

Coronary revascularization for heart failure with coronary artery disease: A systematic review and meta-analysis of randomized trials

Aims

Coronary artery disease (CAD) is a common cause of heart failure (HF). Whether coronary revascularization improves outcomes in patients with HF receiving guideline-recommended pharmacological therapy (GRPT) remains uncertain; therefore, we conducted a systematic review and meta-analysis of relevant randomized controlled trials (RCTs).

Methods and results

We searched in public databases for RCTs published between 1 January 2001 and 22 November 2022, investigating the effects of coronary revascularization on morbidity and mortality in patients with chronic HF due to CAD. All-cause mortality was the primary outcome. We included five RCTs that enrolled, altogether, 2842 patients (most aged <65 years; 85% men; 67% with left ventricular ejection fraction ≤35%). Overall, compared to medical therapy alone, coronary revascularization was associated with a lower risk of all-cause mortality (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.79–0.99; p = 0.0278) and cardiovascular mortality (HR 0.80, 95% CI 0.70–0.93; p = 0.0024) but not the composite of hospitalization for HF or all-cause mortality (HR 0.87, 95% CI 0.74–1.01; p = 0.0728). There were insufficient data to show whether the effects of coronary artery bypass graft surgery or percutaneous coronary intervention were similar or differed.

Conclusions

For patients with chronic HF and CAD enrolled in RCTs, the effect of coronary revascularization on all-cause mortality was statistically significant but neither substantial (HR 0.88) nor robust (upper 95% CI close to 1.0). RCTs were not blinded, which may bias reporting of the cause-specific reasons for hospitalization and mortality. Further trials are required to determine which patients with HF and CAD obtain a substantial benefit from coronary revascularization by either coronary artery bypass graft surgery or percutaneous coronary intervention.     

Comparison of continuous infusion and intermittent boluses of furosemide in acute heart failure: A protocol for systematic review and meta-analysis

Background:Acute heart failure (HF) is a common cause of hospital admission. This study aims to compare continuous infusion and intermittent boluses of furosemide in treating acute HF.Methods:This protocol of systematic review and meta-analysis has been drafted under the guidance of the preferred reporting items for systematic reviews and meta-analyses protocols. Electronic databases including Web of Science, Embase, PubMed, Wanfang, Data, Scopus, Science Direct, and Cochrane Library will be searched in June 2021 by 2 independent reviewers. The main outcomes are post-treatment daily urine output, weight, length of stay, serum sodium, potassium, and creatinine. Two researchers conducted a quality assessment in strict accordance with the risk bias assessment tool recommended by the Cochrane Handbook Version5.3. We performed the meta-analysis by Stata version 10.0 software.Results:The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.Conclusion:The choice of furosemide regime in acute HF remains physician preference. Both bolus and continuous infusion yields satisfactory outcomes.     

Cognitive impairment associated with increased mortality rate in patients with heart failure: A systematic review and meta-analysis

BackgroundRecent systematic review and meta-analysis showed that the prevalence of cognitive impairment was significantly increased in patients with heart failure (HF) when compared to the general population. However, the effect of cognitive impairment on cardiovascular outcome in this population is still unclear. We performed a systematic review and meta-analysis to assess whether cognitive impairment associated with worse outcome in patients with HF.MethodsWe comprehensively searched the databases of MEDLINE and EMBASE from inception to October 2018. Included studies were published cohort (prospective or retrospective) or randomized control trials that evaluate the effect of cognitive impairment mortality in HF patients. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate pooled hazard ratios (HR) and 95% confidence intervals (CI).ResultsEight studies were included in the analysis involving 3318 participants (951 participants had cognitive impairment). In a random-effects model, our analysis demonstrated that cognitive impairment significantly increased the risk of mortality in HF patients (pooled HR = 1.64, 95% CI = 1.42–1.88, I² = 0.0%, p < 0.001).ConclusionOur systematic review and meta-analysis showed that the presence of cognitive impairment is strongly associated with an increased mortality risk in the HF population. Further research is needed to explore the pathophysiology of this association.     

美托洛尔治疗慢性充血性心力衰竭分析

目的　探讨美托洛尔在心力衰竭 (心衰 )治疗中的作用。方法　选择慢性充血性心力衰竭患者 5 3例 ,随机分为两组 ,在常规强心、利尿、扩血管治疗基础上 ,治疗组加用美托洛尔 ,治疗后 4周、8周比较两组患者的临床指标改变。结果　两组患者的临床指标在治疗后 4周、8周均较治疗前有明显改善 ,但治疗组较对照组改善更为显著。结论　在常规抗心衰治疗基础上加用美托洛尔可明显改善患者心功能     

强化利尿并高张盐水在难治性心力衰竭伴低钠血症患者中的疗效观察

目的探讨强化利尿并高张盐水在伴有低钠血症的难治性心力衰竭患者中的疗效。方法收集难治性心力衰竭伴低钠血症患者21例,随机分为11例和10例两组,分别给予1.81%或2.72%高张盐水配合大剂量呋塞米静脉滴注和单纯大剂量呋塞米静脉使用,记录两组患者的心功能、尿量、体重及血钠等指标的变化。结果呋塞米并高张盐水组尿量、体重、血钠由治疗前的595ml/24h±163ml/24h、63.9kg±5.8kg和121.1mmol/L±7.3mmol/L变为治疗后的2186ml/24h±256ml/24h、54.2±4.8kg和137.1mmol/L±4.9mmol/L;在尿量增加、体重减轻、血钠恢复正常等方面明显优于单纯呋塞米组。NYHA心功能分级呋塞米并高张盐水组也显著优于单纯呋塞米组。结论难治性心力衰竭伴低钠血症患者使用高张盐水配合强化利尿可有效减轻水钠潴留,改善心脏功能,并有效纠正低钠血症。其机制可能与高张盐水增加有效循环血量,改善肾脏灌注,抑制神经内分泌激活,增加利尿剂在作用部位浓度等有关。     

Continuous infusion of furosemide in the treatment of patients with congestive heart failure and diuretic resistance

Objectives . To assess the value of treatment with continuous intravenous infusion of furosemide (F) in patients with refractory congestive heart failure. Design . Open uncontrolled dose-response study. Subjects . Patients with congestive heart failure (those with New York Heart Association (NYHA) classes III and IV with an assessed amount of oedema of more than 5 kg and diuretic resistance were included [n = 10]). Diuretic resistance was defined as: failure to lose weight and/or inappropriate urinary sodium excretion (50 mmol 24 h^-1) despite bed rest for a period of 2–3 days, salt and water restriction, orally and intravenously administered furosemide in a dose of 250 mg day^-1, digoxin, and when possible an ACE inhibitor. Included patients were treated with continuous F infusion at a delivery rate of 20 mg^-1 over 24 h. The infusion rate was gradually heightened up to a maximum dose of 160 mg h^-1. Main outcome measures . Daily physical examination, history of side-effects, determination of serum electrolytes and 24-h electrolyte excretion during treatment with furosemide. Results . Weight loss (mean ± sd ; 12.5 ± 5 kg) and relief of symptoms was achieved in all patients. Mean (± sd ) 24-h sodium output rose from 19 ± 16 mmol 24 h^-1 (n = 10) on oral therapy with 250 mg F to 137 ± 85 mmol 24 h^-1 (n = 8) during 80 mg h^-1 and to 268 ± 124 mmol 24 h^-1 (n = 3) on the maximal dose of 160 mg h^-1. Conclusion . Continuous infusion of F under careful monitoring of the patient is a safe, controllable and efficient treatment in patients with severe congestive heart failure and diuretic resistance.     

静脉滴注呋塞米治疗难治性充血性心力衰竭的疗效评价

目的 :评价呋塞米静脉滴注治疗难治性充血性心力衰竭 (CHF)的疗效。方法 :常规治疗加静脉注射呋塞米效果差的CHF 2 3例 ,继用呋塞米静脉滴注 5d ,观察其利尿效应 ,监测治疗前后血压、电解质、心率及体重。治疗过程中适当补充钠、钾和维持血压。结果 :静脉滴注呋塞米后每日尿量较治疗前明显增加 (P <0 .0 1) ;第 2、3、4、5天静脉滴注呋塞米量明显少于静脉滴注前 1天和静脉滴注第 1天剂量 (P <0 .0 5 <0 .0 1) ;治疗后心率、体重及血压显著降低 (P <0 .0 1,<0 .0 1,<0 .0 5 ) ,治疗前后血清钾和钠无明显改变 (均P >0 .0 5 )。治疗后所有患者临床症状和体征明显改善。结论 :在常规治疗下加用静脉滴注呋塞米治疗难治性CHF是一种安全有效的方法。     

持续静脉泵入呋塞米与多巴胺联合黄芪注射液治疗难治性心力衰竭患者利尿剂抵抗

目的观察持续静脉泵人呋塞米与多巴胺并静脉滴注黄芪注射液对难治性心衰患者利尿剂抵抗的疗效、可行性及安全性。方法将47例产生利尿剂抵抗的难治性心衰患者随机分为对照组20例及治疗组27例。对照组采用常规利尿剂及其他抗心衰治疗;治疗组在常规治疗基础上持续静脉泵入呋塞米和多巴胺及静脉滴注黄芪注射液,连用3-5d。观察治疗前、后两组临床症状体征及胸片肺水肿、肺淤血改善情况,以及心功能指标等方面的变化。结果两组治疗后各项观察指标较治疗前都有改善,但治疗组改善更加明显（P〈O．05）,治疗组临床总有效率为85．2％,对照组为45％（P〈0．05）。结论在常规抗心力衰竭治疗基础上,持续静脉泵人呋塞米与多巴胺辅以黄芪注射液静脉滴注对难治性心衰患者利尿剂抵抗疗效显著,临床安全可行。     

Digoxin: A systematic review in atrial fibrillation,congestive heart failure and post myocardial infarction

AIM: To review digoxin use in systolic congestive heart failure, atrial fibrillation, and after myocardial infarction.METHODS: A comprehensive PubMed search was performed using the key words “digoxin and congestive heart failure”, “digoxin and atrial fibrillation”, “digoxin, atrial fibrillation and systolic congestive heart failure”, and “digoxin and myocardial infarction”. Only articles written in English were included in this study. We retained studies originating from randomized controlled trials, registries and included at least 500 patients. The studies included patients with atrial fibrillation or heart failure or myocardial infarction and had a significant proportion of patients (at least 5%) on digoxin. A table reviewing the different hazard ratios was developed based on the articles selected. Our primary endpoint was the overall mortality in the patients on digoxin vs those without digoxin, among patients with atrial fibrillation and also among patients with atrial fibrillation and systolic heart failure. We reviewed the most recent international guidelines to discuss current recommendations.RESULTS: A total of 18 studies were found that evaluated digoxin and overall mortality in different clinical settings including systolic congestive heart failure and normal sinus rhythm (n = 5), atrial fibrillation with and without systolic congestive heart failure (n = 9), and myocardial infarction (n = 4). Overall, patients with systolic congestive heart failure with normal sinus rhythm, digoxin appears to have a neutral effect on mortality especially if close digoxin level monitoring is employed. However, most of the observational studies evaluating digoxin use in atrial fibrillation without systolic congestive heart failure showed an increase in overall mortality when taking digoxin. In the studies evaluated in this systematic review, the data among patients with atrial fibrillation and systolic congestive heart failure, as well as post myocardial infarction were more controversial. The extent to which discrepancies among studies are based on statistical methods is currently unclear, as these studies’ findings are generated by retrospective analyses that employed different techniques to address confounding.CONCLUSION: Based on the potential risks and benefits, as well as the presence of alternative drugs, there is a limited role for digoxin in the management of patients with normal sinus rhythm and congestive heart failure. Based on the retrospective studies reviewed there is a growing volume of data showing increased mortality in those with only atrial fibrillation. The proper role of digoxin is, however, less certain in other subgroups of patients, such as those with both atrial fibrillation and systolic congestive heart failure or after a myocardial infarction. Further studies may provide helpful information for such subgroups of patients.