Ümit GÜRAY, Hakan ALTAY, Erdal DURU, Emre Nuri GÜNEL, Meltem Refiker EGE, Ali ŞAŞMAZ, Yeşim GÜRAY, Şule KORKMAZ, Mehmet Birhan YILMAZ

Factors influencing the dose of loop diuretics in patients with systolic heart failure at discharge from the hospital

Amaç. Sistolik kalp yetersizliği pek çok ilacın kullanıldığı kronik bir hastalıktır. Diüretikler, özellikle kıvrım diüretikleri, hastanaye yatırışan kalp yetersizliği hastalarına sıklıkla başlanır ve sonrasında devam ettirilir. Bununla birlikte diüretikler kalp yetersizliğinde mortalite faydası olmayan, bir özel grup haricinde bi takım riskleri beraberinde getiren ilaç grubudur. Bu yüzden hekimlerin neden bu ilaçlarını kullandıklarını anlamak önemlidir. Biz bu çalışmada kalp yetersizliği hastalarının hastaneden taburculuk raporlarını geriye doğru inceledik. Yöntem. Sistolik kalp yetersizliği olan 700 hasta gözden geçirildi kıvrım diüretiği, furosemid, hastane çıkışındaki dozu orta-yüksek (>40mg /gün) ve düşük doz şeklinde sınıflandırıldı. Bulgular. Taburculuk esnasında 613 hastaya furosemid reçetelenmişti. Çıkışta kötü fonksiyonel sınıf (NYHA FK III-IV) (B=1.894), kreatinin (B=1.567) ve spironolakton reçetelenmesi (B=2.427) çıkışta orta yüksek doz furosemid reçetelenmesi ile bağımsız ilişkili parametreler olarak bulundu. Sonuç. Diüretikler kalp yetersizliğinde kaçınılmaz ilaçlardır. Hekimleri yüksek doz reçetelemeye sevk eden nedenlerin anlaşılması, daha düşük riskli yollara yönelmek için önem olabilir.

Sistolik kalp yetersizliği hastalarında hastaneden taburculukta reçete edilen kıvrım diüretiklerin dozunu etkileyen faktörler

Aim. Systolic heart failure (HF) is a chronic disease, associated with use of many drugs. Diuretics, particularly loop diuretics, are frequently prescribed to patients hospitalized with HF, and kept thereafter. However, diuretics are a group of drugs, which do not provide mortality benefit in HF, and, may bring about some risks, except in a specific group. Hence, it is important to understand the reasons driving physicians to use them. We retrospectively reviewed the hospital discharge records of HF patients. Methods. 700 patients with systolic HF were reviewed. Loop diuretic, furosemide, dose at disharge was classified into two categories as moderate-high (>40 mg/day) and low doses. Results. 613 patients were prescribed furosemide at discharge. Poor functional capacity (FC) (NYHA FC III-IV) at discharge (B=1.894), serum creatinine levels (B=1.567), and spironolactone prescription (B=2.427) were found to be independently associated with moderate-high dose of furosemide prescription during discharge. Conclusion. Diuretics are inevitable in systolic HF. Reasons driving the physicians to prescribe higher doses might be important in drawing pathways towards lower risks

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