2014


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2014/№4

Diuretics in CHF-2013: Realities of use at outpatient and in-patient stages of treatment

Sitnikova M.Yu., Bortsova M.A., Yurchenko A.V., Lyasnikova E.A., Trukshina M.A.
Federal State Budgetary Institution, “North-West Federal Medical Research Center” of the RF Ministry of Health Care, Akkuratova 2, St.-Petersburg 197341

Keywords: diuretics, treatment, CHF


DOI: 10.18087 / rhfj.2014.4.1974

Background. Despite the introduction of neuro-humoral modulators to standards of therapy for CHF, the diuretic treatment (DT) remains the only drug method for reducing and even reversing fluid retention. Aim. To analyze the value of DT and mineralocorticoid receptor antagonist (MCRA) treatment in patients with symptomatic CHF at outpatient and in-patient stages. Materials and methods. The study included 227 patients with FC II–IV CHF and LV EF ≤40 %, who were routinely admitted to the Federal State Budgetary Institution “V. A. Almazov Federal Medical Research Center”. Results. At the time of admission, 82 % of patients were receiving the ACE inhibitor (ACEI) / angiotensin receptor antagonist (ARA) treatment; more than 70 % of patients were receiving β-blockers (BB); and 57.1 % of patients were receiving MCRA. Upon admission, 55.5 % of patients with FC II CHF, 21.3 % of patients with FC III CHF, and 24.1 % of patients with FC IV CHF were not receiving DT or MCRA. 17.8 % of patients with FC II CHF were receiving a loop diuretic (LD) alone, a thiazide diuretic (TD) alone, or MCRA. Among patients with FC III CHF, 53.6 % of patients were receiving a combination therapy with LD+MCRA, 2.7 % of patients were receiving a combination of three drugs (LD+acetazolamide+MCRA), and only 0.9 % of patients were receiving a combination of four drugs (LD+TD+acetazolamide+MCRA). Only 58.6 % of patients with FC IV CHF were treated with LD and 68.9 % were treated with MCRA. During the in-patient treatment, the proportion of patients with FC II CHF receiving LD / TD+MCRA increased from 26.7 % to 88.8 %. Upon discharge, 95.8 % of patients with FC III CHF were treated with LD whereas 87.5 % of patients were treated with MCRA. 8.3 % of patients were treated with the LD+TD+acetazolamide+MCRA combination. Conclusion. The prevalence of outpatient treatment for CHF with ACEI / ARA and BB is presently comparable with that in European Union countries. The outpatient DT treatment does not comply with available guidelines; only 21–53.6 % of patients receive a full-value combination of DT+MCRA while 6.5–13.7 % of patients receive only MCRA. The in-patient DT treatment is more adequate and mostly includes torasemide. 8.3 % of patients with FC III CHF receive combinations of torasemide with TD and 19.4 % of such patients receive combinations of toracemide with carboanhydrase inhibitors.
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Sitnikova M.Yu., Bortsova M.A., Yurchenko A.V., Lyasnikova E.A., Trukshina M.A. Diuretics in CHF-2013: Realities of use at outpatient and in-patient stages of treatment. Russian Heart Failure Journal. 2014;85 (4):207–212.

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