The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators

Connors, Alfred F.; Speroff, Theodore; Nv, Dawson; Thomas, Caroline; Fe, Harrell; Wagner, DouglasP.; Desbiens, Norman A.; Goldman, L; Aw, Wu; Califf, RM; Fulkerson, WJ; Vidaillet, Humberto; Broste, Steven K.; Bellamy, PE; Lynn, Jean; Wa, Knaus

doi:10.1001/jama.276.11.889

Cited by 985 publications

(586 citation statements)

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“…Propensity score matching is a technique used in observational studies to select groups, which are similar on average with respect to potential confounders. [55][56][57][58][59] The confounders included (1) sociodemographic variables (i.e., age, race/ethnicity, education, length of time in MMTP, and employment status), (2) relationship characteristics (i.e., type of intimate relationship(s), length of relationship, and financial dependency), and (3) substance use (i.e., participant_s use of illicit drugs and binge drinking in past 6 months, participant_s reports on intimate partner_s substance use in past 6 months). The selection of these potential confounders was based on previous research on factors associated with both IPV and sexual transmission risks among drug-involved, heterosexual men and women.…”

Section: Discussionmentioning

confidence: 99%

Intimate Partner Violence and HIV Risks: A Longitudinal Study of Men on Methadone

Gilbert

El‐Bassel

et al. 2007

J Urban Health

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Whereas research has suggested that drug-involved men are at disproportionately high risk of engaging in transmission risk behaviors for HIV and of perpetrating intimate partner violence (IPV) against women, only a few cross-sectional studies have examined the relationship between IPV and HIV/sexually transmitted infection (STI) transmission risks among heterosexual, drug-involved men. This study builds on previous cross-sectional research by using a longitudinal design to examine the temporal relationships between perpetration of IPV and different HIV/STI transmission risks among a random sample of 356 men on methadone assessed at baseline (wave 1), 6 months (wave 2), and 12 months (wave 3). The findings indicate that (1) perpetration of IPV in the past 6 months at wave 1 was associated with having more than one intimate partner, buying sex, and sexual coercion at subsequent waves and that (2) noncondom use, injecting drugs, and sexual coercion at wave 1 were associated with subsequent IPV. The temporal relationships between perpetration of IPV and HIV risks found in this study underscore the need for HIV prevention interventions targeting men on methadone to consider IPV and HIV risks as cooccurring problems.

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Section: Discussionmentioning

confidence: 99%

Intimate Partner Violence and HIV Risks: A Longitudinal Study of Men on Methadone

Gilbert

El‐Bassel

et al. 2007

J Urban Health

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“…The included covariates were well balanced across the metolazone and no metolazone groups within blocks of the propensity score. The propensity score successfully adjusted for major covariates of interest that were found to be highly statistically significantly different between the metolazone groups before adjustment 22. Given that uptitration of loop diuretics is the alternate guideline recommended therapy when lower doses are not effective, as a secondary analysis, a second propensity score was developed using multivariable logistic regression with high‐dose loop diuretic use as the dependent variable.…”

Section: Methodsmentioning

confidence: 99%

Outcomes Associated With a Strategy of Adjuvant Metolazone or High‐Dose Loop Diuretics in Acute Decompensated Heart Failure: A Propensity Analysis

Brisco‐Bacik

Maaten

Houser

et al. 2018

JAHA

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BackgroundIn acute decompensated heart failure, guidelines recommend increasing loop diuretic dose or adding a thiazide diuretic when diuresis is inadequate. We set out to determine the adverse events associated with a diuretic strategy relying on metolazone or high‐dose loop diuretics.Methods and ResultsPatients admitted to 3 hospitals using a common electronic medical record with a heart failure discharge diagnosis who received intravenous loop diuretics were studied in a propensity‐adjusted analysis of all‐cause mortality. Secondary outcomes included hyponatremia (sodium <135 mEq/L), hypokalemia (potassium <3.5 mEq/L) and worsening renal function (a ≥20% decrease in estimated glomerular filtration rate). Of 13 898 admissions, 1048 (7.5%) used adjuvant metolazone. Metolazone was strongly associated with hyponatremia, hypokalemia, and worsening renal function (P<0.0001 for all) with minimal effect attenuation following covariate and propensity adjustment. Metolazone remained associated with increased mortality after multivariate and propensity adjustment (hazard ratio=1.20, 95% confidence interval 1.04–1.39, P=0.01). High‐dose loop diuretics were associated with hypokalemia and hyponatremia (P<0.002) but only worsening renal function retained significance (P<0.001) after propensity adjustment. High‐dose loop diuretics were not associated with reduced survival after multivariate and propensity adjustment (hazard ratio=0.97 per 100 mg of IV furosemide, 95% confidence interval 0.90–1.06, P=0.52).ConclusionsDuring acute decompensated heart failure, metolazone was independently associated with hypokalemia, hyponatremia, worsening renal function and increased mortality after controlling for the propensity to receive metolazone and baseline characteristics. However, under the same experimental conditions, high‐dose loop diuretics were not associated with hypokalemia, hyponatremia, or reduced survival. The current findings suggest that until randomized control trial data prove otherwise, uptitration of loop diuretics may be a preferred strategy over routine early addition of thiazide type diuretics when diuresis is inadequate.

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“…In this setting, physicians frequently use invasive measures of volume status, including those obtained from central venous and pulmonary artery catheters. This practice has recently been questioned (68 -70) because evidence indicates an association between right-heart catheterization and increased mortality, length of hospital stay, and cost of care (71). A randomized, controlled study is necessary to further examine this issue (72).…”

Section: Hemodynamic Supportmentioning

confidence: 99%

Diagnosis and Treatment of Acute Tubular Necrosis

Esson

Schrier²

2002

Ann Intern Med

230

147

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The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators

Cited by 985 publications

References 0 publications

Intimate Partner Violence and HIV Risks: A Longitudinal Study of Men on Methadone

Intimate Partner Violence and HIV Risks: A Longitudinal Study of Men on Methadone

Outcomes Associated With a Strategy of Adjuvant Metolazone or High‐Dose Loop Diuretics in Acute Decompensated Heart Failure: A Propensity Analysis

Diagnosis and Treatment of Acute Tubular Necrosis

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