Association between loop diuretic dose changes and outcomes in chronic heart failure: observations from the ESC‐EORP Heart Failure Long‐Term Registry

Abstract

Guidelines recommend down-titration of loop diuretics (LD) once euvolaemia is achieved. In outpatients with heart failure (HF), we investigated LD dose changes in daily cardiology practice, agreement with guideline recommendations, predictors of successful LD down-titration and association between dose changes and outcomes.

Mortality and pathophysiology of acute kidney injury according to time of occurrence in acute heart failure

“…heart failure therapy, hemodynamic stress (NT‐proBNP) and decongestion (haemoconcentration)] to be similar in both AKI groups, which appears to support our conclusions. Furthermore, the degree of persistent acute renal dysfunction and the need for chronic diuretic therapy at discharge were significantly lower in patients initially presenting with CA‐AKI 12 …”

August 2020 at a glance: focus on neurohormonal antagonists and electrolytes

“…Data from the ESC‐HFA EORP HF Long‐Term Registry showed that diuretic dose increase (vs. no change) was associated with HF death, while a decrease had a trend for better outcomes. Predictors of successful down‐titration of loop diuretics were higher systolic blood pressure, the absence of sleep apnoea, peripheral congestion and significant mitral regurgitation 17 …”

Do chronic heart failure patients receive optimal decongestive interventions in a real‐life setting? Letter regarding the article ‘Association between loop diuretic dose changes and outcomes in chronic heart failure: observations from the ESC‐EORP Heart Failure Long‐Term Registry’

“…2 Given the low rate of LD adjustments, it may be speculated that clinical assessment was not sufficiently extensive, at least in some patients. 1 In contrast to down-titration, up-titration was related to worse outcome. The authors noted that extensive adjustment was done to prove the independence of up-titration as a risk factor.…”

“…We read with interest the recent investigation by Kapelios et al 1 concerning the analysis of the European Society of Cardiology Heart Failure Long-Term (ESC-HF-LT) registry. It underscores the widespread inertia in congestion management, as only 24% of patients underwent loop diuretic (LD) dose modification in ESC-HF-LT registry.…”

“…The authors also found that successful decongestion is unlikely for patients with peripheral oedema. 1 Still, peripheral oedema is not the best parameter to guide decongestion, given the high prevalence of causes other than chronic heart failure (CHF). In daily practice, clinical signs and symptoms remain the cornerstone of congestion assessment, but an extensive clinical investigation is crucial.…”