High Furosemide Doses Increase Mortality and Morbidity in Stable Chronic Heart Failure: A Prospective, Randomized Study

Terrovitis, John; Kapelios, Chris J.; Kaldara, Elisabeth; Ntalianis, Argyrios; Sousonis, Vasilios; Sfakianaki, Titika; Margari, Zafeiria; Nanas, John N.

doi:10.1016/s0735-1097(13)60765-2

Cited by 2 publications

(3 citation statements)

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“…Adjustment of diuretic dosing according to fluid overload has been related with more favorable prognosis. 10,11 In our clinic, furosemide dose is determined during each appointment in respect to the actual volume status (presence of edema, rales, orthopnea, weight control, jugular venous pressure) and overall clinical condition (NYHA class, laboratory test), assuring that the prescribed therapy responds to the individual's demands. The need for dynamic furosemide dose analysis was reaffirmed by the frequent dose readjustments; one-half of patients altered diuretic dose within 1 year after referral, more often toward higher doses.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Effect of the Dose of Loop Diuretic Over 5 Years in Chronic Heart Failure

Laszczyńska

Severo

Friões

et al. 2017

Journal of Cardiac Failure

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Background: High diuretic doses in chronic heart failure (HF) are potentially deleterious. We assessed the effect of dynamic furosemide dose on all-cause mortality among HF ambulatory patients. Methods and Results: A cohort of 560 ambulatory patients from an outpatient clinic specialized in HF, with median age 70 years, 67% male, and 89% with moderate-severely reduced ejection fraction, was retrospectively followed for up to 5 years. Dynamic furosamide exposure was categorized as low (0-59 mg/ d), medium (60-119 mg/d), high (120-159 mg/d), and very high (≥160 mg/d). Extended Cox models were used to estimate the association between time-varying diuretic dose and mortality. A dose-dependent crude association between higher doses of furosemide and death (hazard ratio [HR] = 1.34, 95% confidence interval (CI): 1.06-2.16; HR = 2.09, 95% CI: 1.54-2.84, for high and very high dose, respectively) was totally explained by patients' characteristics and disease severity indicators (adjusted HR = 0.94, 95% CI: 0.63-1.38; HR = 1.10, 95% CI: 0.79-1.55, for high and very high dose, respectively). Conclusion: In this context, higher doses of diuretic did not impair survival, but rather indicated greater severity of the patient's condition.

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Section: Discussionmentioning

confidence: 99%

Prognostic Effect of the Dose of Loop Diuretic Over 5 Years in Chronic Heart Failure

Laszczyńska

Severo

Friões

et al. 2017

Journal of Cardiac Failure

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“…Our data suggest that future studies are needed to understand the impact of changing chronic diuretic doses after a hospitalization for heart failure, including assessing the impact on patient symptoms of congestion and renal function. As recently demonstrated, prospective clinical trials are feasible and may provide insight into optimal dosing of this common and necessary class of medication . Clinical trials using a pragmatic study design as currently advocated by the National Institutes of Health and other research organizations would be well suited to address these questions …”

Section: Discussionmentioning

confidence: 99%

“…As recently demonstrated, prospective clinical trials are feasible and may provide insight into optimal dosing of this common and necessary class of medication. 15,16 Clinical trials using a pragmatic study design as currently advocated by the National Institutes of Health and other research organizations would be well suited to address these questions. 17,18…”

Section: Table 2 Association Between Changes In Oral Loop Diuretic Domentioning

confidence: 99%

Loop diuretic dose adjustments after a hospitalization for heart failure: insights from ASCEND‐HF

DeVore

Hasselblad

Mentz

et al. 2015

European J of Heart Fail

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Aims Loop diuretics are a cornerstone of heart failure (HF) treatment, but data regarding diuretic dose adjustments after a HF hospitalization and the association with subsequent outcomes are limited. This study was therefore conducted to determine these factors. Methods and results We analysed data from 6119 patients enrolled in ASCEND‐HF, examining the association between loop diuretic use at the time of discharge, compared with admission, and the composite outcome of 30‐day HF re‐hospitalization or all‐cause mortality. The majority of patients, 3921 (64%), were taking a loop diuretic on admission. At discharge, 3411 (56%) patients were prescribed higher doses compared with admission, including 1867 (31%) initiating daily outpatient diuretics; 1912 (31%) had no dose change and 795 (13%) were prescribed lower doses compared with admission. Initiation of an oral loop diuretic at discharge was independently associated with better 30‐day outcomes compared with no dose change [adjusted odds ratio (OR) 0.51, 95% confidence interval (CI) 0.37–0.68]. However, for patients that were already established on a loop diuretic prior to admission, change in the dose at discharge was not associated with improved outcomes compared with no dose change (adjusted OR 0.92, 95% CI 0.79–1.07). Conclusions In a large multinational clinical trial, 56% of patients hospitalized with HF were either initiated on a daily loop diuretic at discharge or discharged on higher doses compared with admission. In patients established on diuretics prior to hospitalization, we found no association between changes to chronic doses at discharge and improved outcomes, whereas initiation of loop diuretic therapy was associated with better outcomes compared with no dose change.

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High Furosemide Doses Increase Mortality and Morbidity in Stable Chronic Heart Failure: A Prospective, Randomized Study

Cited by 2 publications

References 0 publications

Prognostic Effect of the Dose of Loop Diuretic Over 5 Years in Chronic Heart Failure

Prognostic Effect of the Dose of Loop Diuretic Over 5 Years in Chronic Heart Failure

Loop diuretic dose adjustments after a hospitalization for heart failure: insights from ASCEND‐HF

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