Impact of Intravenous Loop Diuretics on Outcomes of Patients Hospitalized with Acute Decompensated Heart Failure: Insights from the ADHERE Registry

Peacock, W. Franklin; Costanzo, María Rosa; Marco, Teresa De; Lopatin, Margarita; Wynne, Janet; Mills, Roger M.; Emerman, Charles L.

doi:10.1159/000164149

Cited by 228 publications

(167 citation statements)

References 51 publications

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“…reported that diuretic resistance occurred in over one third of patients with HF and was associated with poor prognosis 9. Several studies showed that high‐dose furosemide usage was associated with poor prognosis in patients with HF regardless of an intravenous or oral administration route 9, 10, 25, 26. On the other hand, Testani et al .…”

Section: Discussionmentioning

confidence: 99%

The association between high‐dose loop diuretic use at discharge and cardiovascular mortality in patients with heart failure

et al. 2017

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AimsFew studies have reported the impact of high‐dose loop diuretics at discharge on prognosis in Japanese patients with heart failure (HF). Our purpose was to assess the relationship between the dose of loop diuretics at discharge and cardiovascular mortality in patients with HF.Methods and resultsWe enrolled decompensated HF patients who were admitted to our hospital between March 2010 and March 2015, and compared HF patients who received high‐dose loop diuretics at discharge (HD group) with low‐dose loop diuretics at discharge (LD group) with regard to risk of cardiovascular mortality, and all‐cause mortality. High‐dose loop diuretic was defined as ≥40 mg/day of oral furosemide at discharge. A total of 215 patients were enrolled to the study. The median follow‐up duration was 641 days. All‐cause and cardiovascular mortality were significantly lower in the LD group than in the HD group (10.4% vs. 31.6%, P < 0.001; 2.2% vs. 24.6%, P < 0.001, respectively). High‐dose loop diuretics were associated with cardiovascular mortality in multivariate Cox proportional hazards model (hazard ratio, 16.06, 95% confidence interval 3.457 to 116.8; P < 0.001). The largest area under the receiver operating characteristic curve (0.85) for cardiovascular death was obtained with a threshold of 40 mg furosemide.ConclusionsHigh‐dose loop diuretic use at discharge was one of the predictors of cardiovascular mortality in patients with HF. An oral furosemide dose of 40 mg daily may be defined as ‘high‐dose’ loop diuretics in Japanese patients with chronic HF.

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Section: Discussionmentioning

confidence: 99%

The association between high‐dose loop diuretic use at discharge and cardiovascular mortality in patients with heart failure

et al. 2017

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“…20 Increased risk for in-hospital mortality and renal failure have been seen with higher doses of IV loop diuretics compared with lower doses. 21 The duration of diuretic therapy may be a prognostic factor and predictor of morbidity by impacting hospital length of stay. 22 Hospital length of stay can be due to extent of congestion, but several actions exerted by parenteral diuretics may independently contribute to in-hospital complications.…”

Section: Clinical Studies In Heart Failurementioning

confidence: 99%

“…34 With increasing concerns in recent years, we have to be cognizant about liberal use of loop diuretics. 21 Loop diuretics should be used modestly, with constant dosage adjustment and with regular clinical assessment. Although literature supports several strategies for volume management, removal of excess extracellular fluid with diuretics is still the mainstay of ADHF therapy.…”

Section: Clinical Studies In Heart Failurementioning

confidence: 99%

Loop Diuretic Therapy in Heart Failure: The Need for Solid Evidence on a Fluid Issue

Chiong

Cheung

2010

Clinical Cardiology

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BackgroundHeart failure (HF) is a common condition associated with substantial cost, morbidity, and mortality. Because results of clinical trials in the acute decompensated heart failure (ADHF) setting have been mostly neutral, loop diuretics remain the mainstay of treatment.HypothesisLoop diuretic use may be associated with unfavorable outcomes.MethodsA MEDLINE literature search was performed to identify articles relating to heart failure and loop diuretics. The current evidence on the risks and benefits of loop diuretics for the treatment of ADHF is reviewed.ResultsLoop diuretics are associated with symptomatic improvements in congestion, urine output, and body weight, but have shown no long‐term mortality benefit. Loop diuretics, especially at high doses, are associated with worsened renal function and other poor outcomes.ConclusionsLoop diuretics still prove useful in HF treatment, but risk‐benefit analysis of these agents in the treatment of ADHF requires a well‐designed prospective study. Copyright © 2010 Wiley Periodicals, Inc.

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“…1) Diuretics are usually the first-line therapy and are most frequently used for ADHF treatment, but have a possibility of worsening the renal function and prognosis of heart failure patients. [2][3][4][5] Carperitide, which is a recombinant of human atrial natriuretic peptide and produces vasodilation and natriuretic effects, is used frequently (58.2%) in Japan according to a large-scale multicenter cohort study; ATTEND registry. 6) Several reports revealed the efficacy and safety of carperitide in acute phase treatment and improvement of long-term prognosis after administration of carperitide in patients with heart failure.…”

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confidence: 99%

Vasopressin V<sub>2</sub> Receptor Antagonist Tolvaptan Is Effective in Heart Failure Patients With Reduced Left Ventricular Systolic Function and Low Blood Pressure

Suzuki¹,

Yoshihisa²,

Yamaki³

et al. 2015

Int. Heart J.

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on behalf of the AVCMA investigators SummaryDiuresis is a major therapy for the reduction of congestive symptoms in acute decompensated heart failure (ADHF) patients. Carperitide has natriuretic and vasodilatory effects, and tolvaptan produces water excretion without electrolyte excretion. We previously reported the usefulness of tolvaptan compared to carperitide in ADHF patients with fluid volume retention. The purpose of this study was to examine whether the efficacy of tolvaptan was altered in ADHF patients with reduced left ventricular systolic function and in those with hypotension. A total of 109 hospitalized ADHF patients were randomly assigned to either a tolvaptan or a carperitide treatment group. Baseline clinical characteristics were not different between the two groups. We divided these patients based on the left ventricular ejection fraction (EF) by echocardiography, and blood pressure (BP) at the time of admission. Daily urine volume between the tolvaptan and carperitide groups in patients with preserved EF (≥ 50%) was not different, however, in those with reduced EF (< 50%), the urine volume was significantly higher in the tolvaptan group than in the carperitide group (day 2, 3, 4, P < 0.05 for all). Daily urine volume did not differ between these two groups in the high blood pressure group (BP ≥ 140 mmHg), but was significantly higher in the tolvaptan group than in the carperitide group (day 1, P = 0.021; day 3, P = 0.017) in the low blood pressure group (BP < 140 mmHg). The present study reveals that tolvaptan is more effective than carperitide, especially in ADHF patients with reduced left ventricular systolic function and without hypertension. (Int Heart J 2015; 56: 213-218)

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Impact of Intravenous Loop Diuretics on Outcomes of Patients Hospitalized with Acute Decompensated Heart Failure: Insights from the ADHERE Registry

Cited by 228 publications

References 51 publications

The association between high‐dose loop diuretic use at discharge and cardiovascular mortality in patients with heart failure

The association between high‐dose loop diuretic use at discharge and cardiovascular mortality in patients with heart failure

Loop Diuretic Therapy in Heart Failure: The Need for Solid Evidence on a Fluid Issue

Vasopressin V<sub>2</sub> Receptor Antagonist Tolvaptan Is Effective in Heart Failure Patients With Reduced Left Ventricular Systolic Function and Low Blood Pressure

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