Lowering furosemide dose in stable chronic heart failure patients with reduced ejection fraction is not accompanied by decompensation: A randomized study

Kapelios, Chris J.; Kaldara, Elisabeth; Ntalianis, Argyrios; Nana, Emmeleia; Pantsios, Chris; Repasos, Evangelos; Margari, Zafeiria; Sousonis, Vasileios; Malliaras, Konstantinos; Nanas, John N.

doi:10.1016/j.ijcard.2014.09.156

Cited by 24 publications

(22 citation statements)

References 10 publications

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“…In this line, a reduction of furosemide dose of ≥120 mg to a third of the baseline dose in patients with HF, has been associated with increased 1-and 2-year survival rates free of hospitalization or cardiac death [36]. Our results extend this knowledge by strongly linking the dose of ≥250 mg to hyponatremia.…”

Section: Discussionsupporting

confidence: 75%

Furosemide and spironolactone doses and hyponatremia in patients with heart failure

Velat

Bušić

Paić

et al. 2020

BMC Pharmacol Toxicol

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Background: Hyponatremia, a marker of disease severity and prognosis, has been associated with various clinical factors and drug use, especially diuretics. Methods: This observational prospective cohort study enrolled patients hospitalized at the University Hospital Center Split because of heart failure (HF). We investigated the association of clinical variables and cardiovascular drugs, including furosemide, hydrochlorothiazide, spironolactone, and their doses, with the presence of hyponatremia at admission. Results: Of the 565 included patients, 32.4% were hyponatremic, 62.6% were males, and the mean age was 73.1 ± 10.6 years. In the univariate analysis, hyponatremic patients were more often current smokers (p = 0.01), alcohol consumers (p = 0.01), receiving spironolactone (p = 0.004) or combination of furosemide and spironolactone (p = 0.003). Patients who received 50 and 100 mg of spironolactone, compared to those receiving 25 mg (p < 0.0001), as well as patients who received 250 to 500 mg of furosemide compared to ≤240 mg (p = 0.001), were significantly more often hyponatremic. In the multivariate analysis, when diuretic doses were accounted for, furosemide doses of 250 to 500 mg (p = 0.009), spironolactone doses of 50 to 100 mg (p = 0.0003), increasing age (p = 0.03), diabetes mellitus (p = 0.02) and alcohol consumption (p = 0.04) were independently associated with hyponatremia. Conclusion: High doses of furosemide and spironolactone, or concomitant use of these diuretics, seem to be an important cause of hyponatremia in HF patients, particularly in combination with advanced age, diabetes and alcohol consumption. Diuretic dose reduction may help avoid hyponatremia and improve clinical status and prognosis in such patients.

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Section: Discussionsupporting

confidence: 75%

Furosemide and spironolactone doses and hyponatremia in patients with heart failure

Velat

Bušić

Paić

et al. 2020

BMC Pharmacol Toxicol

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“…A recent pilot study illustrated the potential of self‐measuring urine chloride content after loop diuretic intake using a dipstick to determine the need for maintenance loop diuretics in stable ambulatory heart failure patients . Despite the guideline recommendation to use the lowest possible dose of diuretics and discontinue loop diuretics if possible, little information is available on discontinuing loop diuretics in contemporary treated heart failure patients . A prospective interventional study in 50 stable ambulatory heart failure patients assessed the feasibility of loop diuretic down‐titration and discontinuation .…”

Section: Diuretics In Chronic Heart Failurementioning

confidence: 99%

“…136 Despite the guideline recommendation to use the lowest possible dose of diuretics and discontinue loop diuretics if possible, little information is available on discontinuing loop diuretics in contemporary treated heart failure patients. 137,138 A prospective interventional study in 50 stable ambulatory heart failure patients assessed the feasibility of loop diuretic down-titration and discontinuation. 138 At 30 days, down-titration remained successful in 62% of patients, however baseline investigations including physical examination, echocardiography and NP measurement were not capable to predict in which patients loop diuretic down-titration would be successful or not.…”

Section: Diuretics In Chronic Heart Failure the Ambulatory Loop Diurementioning

confidence: 99%

The use of diuretics in heart failure with congestion — a position statement from the Heart Failure Association of the European Society of Cardiology

Mullens

Damman

Harjola

et al. 2019

European J of Heart Fail

721

697

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The vast majority of acute heart failure episodes are characterized by increasing symptoms and signs of congestion with volume overload. The goal of therapy in those patients is the relief of congestion through achieving a state of euvolaemia, mainly through the use of diuretic therapy. The appropriate use of diuretics however remains challenging, especially when worsening renal function, diuretic resistance and electrolyte disturbances occur. This position paper focuses on the use of diuretics in heart failure with congestion. The manuscript addresses frequently encountered challenges, such as (i) evaluation of congestion and clinical euvolaemia, (ii) assessment of diuretic response/resistance in the treatment of acute heart failure, (iii) an approach towards stepped pharmacologic diuretic strategies, based upon diuretic response, and (iv) management of common electrolyte disturbances. Recommendations are made in line with available guidelines, evidence and expert opinion.

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“…One meta‐analysis of small randomized trials suggests diuretics may improve outcomes, but observational studies have suggested a significant dose‐dependent association between LD use and adverse outcome in CHF . Higher LD doses may represent a marker of disease severity rather than a true risk factor, though this has also been identified in a small randomized study …”

Section: Introductionmentioning

confidence: 99%

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

Kapelios

Laroche

Crespo-Leiro

et al. 2020

European J of Heart Fail

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Lowering furosemide dose in stable chronic heart failure patients with reduced ejection fraction is not accompanied by decompensation: A randomized study

Cited by 24 publications

References 10 publications

Furosemide and spironolactone doses and hyponatremia in patients with heart failure

Furosemide and spironolactone doses and hyponatremia in patients with heart failure

The use of diuretics in heart failure with congestion — a position statement from the Heart Failure Association of the European Society of Cardiology

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

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