Benefits of guideline-directed medical therapy to loop diuretics in management of heart failure

: Background : We sought to compare the outcomes of patients receiving combination therapy of diuret-ics and neurohormonal blockers, with a matched cohort with monotherapy of loop diuretics, using real-world big data. Methods : This study was based on the Diagnosis Procedure Combination database in the Japanese Registry of All Cardiac and Vascular Datasets (JROAD-DPC). After exclusion criteria, we identified 78,685 pa- tients who were first hospitalized with heart failure (HF) between April 2015 and March 2017. Propensity score (PS) was estimated with logistic regression model, with neurohormonal blockers (angiotensin-converting en-zyme inhibitor : ACEi or angiotensin receptor blocker : ARB, 6-blockers and mineralocorticoid receptor antago-nists : MRA) as the dependent variable and 24 clinically relevant covariates to compare the in-hospital mortality between monotherapy of loop diuretics and combination therapies. Results : On PS-matched analysis, patients with ACEi/ ARB, 6-blockers, and MRA had lower total in-hospital mortality and in-hospital mortality within 7 days, 14 days and 30 days. In the sub-group analysis, regardless of clinical characteristics including elderly peo- ple and cancer, patients treated with a combination of loop diuretics and neurohormonal blockers had signifi- cantly lower in-hospital mortality than matched patients. Conclusions : Our data indicate the benefits of guide-line-directed medical therapy to loop diuretics in the management of HF. J. Med. Invest. 70 : 41-53, February, 2023