Article ; Online: Diuretic treatment before and after transcatheter aortic valve implantation: A Danish nationwide study.
2023 Volume 18, Issue 3, Page(s) e0282636
Abstract: Objectives: We examined loop diuretic treatment before and 1-year after transcatheter aortic valve implantation (TAVI), as a proxy for changes in symptom severity and secondly assessed how changes in loop diuretics related to mortality risk.: ... ...
| Abstract | Objectives: We examined loop diuretic treatment before and 1-year after transcatheter aortic valve implantation (TAVI), as a proxy for changes in symptom severity and secondly assessed how changes in loop diuretics related to mortality risk. Background: Randomized clinical trials suggest that approximately one third of patients undergoing TAVI do not achieve symptom relief, but "all-comer" data are lacking. Methods: Using Danish nationwide registries, we identified all citizens, who underwent TAVI from 2008 to 2019 and were alive at 1-year post-discharge. Loop diuretic treatment pre-TAVI and at 1-year post-TAVI were assessed and grouped as receiving 1) no-loop diuretics; 2) low: 1-40 mg of furosemide (or equivalent bumetanide) daily; 3) intermediate: 41-120 mg of furosemide daily; or 4) high: >120 mg furosemide daily. Results: Among the 4431 patients undergoing TAVI, 2173 (49%) patients were not treated with loop diuretics at the time of TAVI, 918 (21%) had low-loop diuretics, 881 (20%) had intermediate-loop diuretics, and 459 (10%) had high-loop diuretics. At 1-year post-TAVI, 893 (20%) patients had increased, 1010 (23%) had reduced, and 2528 (57%) had unchanged loop diuretic treatment. The cumulative 5-year risk of death in patients surviving one year, was 61% (95% CI: 56.4% to 65.3%) in patients with increased and 47% (95% CI: 44.9% to 49.9%) in patients with reduced/unchanged loop diuretic treatment, respectively. In multivariable Cox proportional hazard analysis, increased loop diuretic treatment was associated with a higher risk of death compared with reduced/unchanged loop diuretic treatment (Hazard ratio: 1.4; 95% CI: 1.22 to 1.52). Conclusions: Among patients undergoing TAVI, surviving one year, one fifth of patients had increased loop diuretic treatment, and a little over one fifth had reduced loop diuretic treatment 1-year post-procedure. In patients with increased diuretic treatment, the risk of death was higher compared to those with reduced/unchanged loop diuretic treatment. |
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| MeSH term(s) | Humans ; Transcatheter Aortic Valve Replacement/adverse effects ; Aortic Valve Stenosis/drug therapy ; Aortic Valve Stenosis/surgery ; Aortic Valve Stenosis/complications ; Furosemide/therapeutic use ; Aftercare ; Risk Factors ; Patient Discharge ; Heart Valve Prosthesis Implantation/adverse effects ; Sodium Potassium Chloride Symporter Inhibitors/therapeutic use ; Denmark/epidemiology ; Treatment Outcome ; Aortic Valve/surgery |
| Chemical Substances | Furosemide (7LXU5N7ZO5) ; Sodium Potassium Chloride Symporter Inhibitors |
| Language | English |
| Publishing date | 2023-03-16 |
| Publishing country | United States |
| Document type | Journal Article |
| ZDB-ID | 2267670-3 |
| ISSN | 1932-6203 ; 1932-6203 |
| ISSN (online) | 1932-6203 |
| ISSN | 1932-6203 |
| DOI | 10.1371/journal.pone.0282636 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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