包括皮下注射呋塞米在内的住院心力衰竭患者早期出院策略。
完整摘要 · 中文译文
背景：因心力衰竭住院的患者通常需要长时间的静脉利尿剂治疗，增加了住院治疗相关的费用和风险。 目的：我们评估了采用可穿戴微型泵皮下注射呋塞米的早期出院策略能否增加存活且出院天数（DAOH）。 方法：在这项于英国开展的多中心、开放标签、随机、活性对照试验中，172 例因心力衰竭住院且需要持续肠外利尿剂治疗的患者被随机分配至早期出院策略组或常规治疗组。早期出院组患者通过可穿戴、由患者操作的微型泵接受 pH 中性皮下呋塞米治疗；出院后在接受皮下呋塞米期间每 3 天复查一次。两组均在 2 周时进行门诊复查。主要结局为随机化后 30 天时的 DAOH。 结果：共有 92 例患者被分配至早期出院组，80 例被分配至常规治疗组。早期出院策略使 30 天时 DAOH 增加 4.0 天（95% CI：2.1～5.8 天；P < 0.001）。首次住院时间平均缩短 5.5 天（95% CI：7.4～3.6 天；P < 0.001）。DAOH 的获益在 60 天时仍持续存在（差异为 4.2 天；95% CI：0.9～7.6 天），尽管早期出院组心力衰竭再入院人数更多（13 例 [14%] 患者 vs 5 例 [6%] 患者；OR：2.45；95% CI：0.81～7.43）。严重不良事件发生率分别为 25% 和 23%。3% 的微型泵放置发生装置相关问题，但均不严重。 结论： 采用皮下呋塞米微型泵的早期出院策略与常规治疗相比，增加了院外存活天数。（一种新型皮下呋塞米制剂用于促进心力衰竭患者早期支持性出院的研究 [SUBCUT-HF II]；NCT05419115）。
完整摘要 · 英文原文
BACKGROUND: Patients hospitalized for heart failure often require prolonged intravenous diuretic therapy, contributing to costs and risks associated with inpatient care. OBJECTIVES: We evaluated whether an early discharge strategy using subcutaneous furosemide delivered via a wearable minipump could increase days alive and out of hospital (DAOH). METHODS: In this multicenter, open-label, randomized, active-controlled trial in the United Kingdom, 172 patients hospitalized for heart failure requiring ongoing parenteral diuretics were randomly assigned to an early discharge strategy or usual care. Patients in the early discharge group received pH-neutral subcutaneous furosemide via a wearable, patient-operated minipump; postdischarge care included a review every 3 days while receiving subcutaneous furosemide. Both groups had a 2-week clinic review. The primary outcome was DAOH at 30 days after randomization. RESULTS: A total of 92 patients were assigned to early discharge and 80 to usual care. The early discharge strategy resulted in 4.0 more DAOH at 30 days (95% CI: 2.1-5.8 days; P < 0.001). Index hospitalization was shorter by a mean of 5.5 days (95% CI: 7.4-3.6 days; P < 0.001). The benefit in DAOH was sustained at 60 days (difference 4.2 days; 95% CI: 0.9-7.6 days), despite more heart failure readmissions in the early discharge group (13 [14%] patients vs 5 [6%] patients; OR: 2.45; 95% CI: 0.81-7.43). Serious adverse events occurred in 25% and 23% of patients, respectively. Device-related problems occurred with 3% of minipump placements, but none were serious. CONCLUSIONS: An early discharge strategy using a subcutaneous furosemide minipump increased DAOH compared with usual care. (Use of a Novel SUBCUTaneous Preparation of Furosemide to Facilitate Early Supported Discharge of Patients With Heart Failure [SUBCUT-HF II]; NCT05419115).