Participation in a clinical trial is associated with lower mortality but not lower risk of HF hospitalization in patients with heart failure: observations from the ESC EORP Heart Failure Long-Term Registry

Kapelios, Chris J.; Benson, Lina; Crespo-Leiro, María G.; Anker, Stefan D.; Coats, Andrew J.S.; Chioncel, Ovidiu; Filippatos, Gerasimos; Lainščak, Mitja; McDonagh, Theresa A.; Mebazaa, Alexandre; Metra, Marco; Piepoli, Massimo F; Rosano, Giuseppe; Ruschitzka, Frank; Savarese, Gianluigi; Seferović, Petar; Volterrani, Maurizio; Maggioni, Aldo P.; Lund, Lars H.

doi:10.1093/eurheartj/ehad109

Cited by 14 publications

(19 citation statements)

References 10 publications

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“…Kapelios et al . reported that an increase in loop diuretic doses compared with no change was associated with higher risk of HF death after index visit, whereas a decrease in loop diuretic doses compared with no change showed a trend of lower HF and cardiovascular deaths after index visit in outpatients with chronic HF 16 . Furthermore, novel effective, safe pharmacologic, and established methods to achieve decongestion without inducing end‐organ damage are needed.…”

Section: Discussionmentioning

confidence: 99%

“…The dose of loop diuretics was calculated as a furosemide equivalent for patients who had received loop diuretics other than furosemide. The formula used to convert other loop diuretics to furosemide equivalents was as follows: furosemide 20 mg = azosemide 30 mg = torasemide 10 mg. 15,16 Changes in the dose of loop diuretics during hospitalization were calculated by comparing the dose at discharge with the dose at admission. Anaemia was defined using the World Health Organization criteria (haemoglobin of <12.0 g/dL in women and <13.0 g/dL in men).…”

Section: Data Collection and Definitionsmentioning

confidence: 99%

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Association between changes in loop diuretic dose and outcomes in acute heart failure

et al. 2023

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Aims Little is known about the association between the starting of or dose changes in loop diuretics during acute heart failure (AHF) hospitalization and post‐discharge outcomes. We investigated the clinical impact of starting loop diuretics and changing the loop diuretics dose during hospitalization on post‐discharge outcomes. Methods and results From the Kyoto Congestive Heart Failure registry, 3665 consecutive patients hospitalized for HF and discharged alive were included in this study. We analysed 1906 patients without loop diuretics on admission and were discharged alive and 1759 patients who received loop diuretics on admission and were discharged alive. The primary outcome measure was all‐cause death. Of the 1906 patients without loop diuretics on admission, 1366 (71.7%) patients started loop diuretics during the index AHF hospitalization. Starting loop diuretics was not associated with lower post‐discharge mortality [adjusted hazard ratio (HR) 0.92, 95% confidence interval (CI) 0.68–1.25]. Of the 1759 patients who received loop diuretics on admission, loop diuretic dose was decreased in 23.8%, unchanged in 44.6%, and increased in 31.6% of the patients. Changes in the dose at discharge compared with no change in dose were not associated with lower risk of post‐discharge mortality (decrease relative to no change: adjusted HR 0.98, 95% CI 0.76–1.28; increase relative to no change: adjusted HR 1.00, 95% CI 0.78–1.27). Compared with no loop diuretics at discharge, a loop diuretics dose of ≥80 mg at discharge was associated with higher post‐discharge mortality risk. Conclusions In patients with AHF, we found no association between the starting of loop diuretics and post‐discharge outcomes and between dose changes and post‐discharge outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Data Collection and Definitionsmentioning

confidence: 99%

Association between changes in loop diuretic dose and outcomes in acute heart failure

et al. 2023

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“…Complete decongestion while carefully monitoring renal function and electrolytes, is the target 9,61,97 . Several studies showed that high doses of loop diuretic are associated with an increased risk of mortality, even after multivariate adjustment or propensity matching 9,68,69,98,99 . Potential bias remains as sicker patients are more likely to receive higher doses of loop diuretics.…”

Section: Pre‐discharge Optimization Of Treatmentmentioning

confidence: 99%

Pre‐discharge and early post‐discharge management of patients hospitalized for acute heart failure: A scientific statement by the Heart Failure Association of the ESC

Metra

Adamo

Tomasoni

et al. 2023

European J of Heart Fail

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Acute heart failure is a major cause of urgent hospitalizations. These are followed by marked increases in death and rehospitalization rates, which then decline exponentially though they remain higher than in patients without a recent hospitalization. Therefore, optimal management of patients with acute heart failure before discharge and in the early post‐discharge phase is critical. First, it may prevent rehospitalizations through the early detection and effective treatment of residual or recurrent congestion, the main manifestation of decompensation. Second, initiation at pre‐discharge and titration to target doses in the early post‐discharge period, of guideline‐directed medical therapy may improve both short‐ and long‐term outcomes. Third, in chronic heart failure, medical treatment is often left unchanged, so the acute heart failure hospitalization presents an opportunity for implementation of therapy. The aim of this scientific statement by the Heart Failure Association of the European Society of Cardiology is to summarize recent findings that have implications for clinical management both in the pre‐discharge and the early post‐discharge phase after a hospitalization for acute heart failure.

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“…Over the last years, the development of new drugs has revolutionized the treatment of HF, especially in those who suffer HF with reduced ejection fraction (HFrEF) 1,2 . However, there are several, worrisome signals indicating that newer therapies do not always reach the target population for many reasons 3–5 . Specifically, out‐of‐pocket cost, medical inertia or drug intolerance/side‐effects are some of them.…”

Section: Figurementioning

confidence: 99%

“…1,2 However, there are several, worrisome signals indicating that newer therapies do not always reach the target population for many reasons. [3][4][5] Specifically, out-of-pocket cost, medical inertia or drug intolerance/side-effects are some of them. How can we overcome these barriers?…”

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confidence: 99%

Sacubitril/valsartan adherence… because the best is sometimes difficult to replace the good

Álvarez‐García

2022

European J of Heart Fail

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Participation in a clinical trial is associated with lower mortality but not lower risk of HF hospitalization in patients with heart failure: observations from the ESC EORP Heart Failure Long-Term Registry

Abstract: Abstract

Cited by 14 publications

References 10 publications

Association between changes in loop diuretic dose and outcomes in acute heart failure

Association between changes in loop diuretic dose and outcomes in acute heart failure

Pre‐discharge and early post‐discharge management of patients hospitalized for acute heart failure: A scientific statement by the Heart Failure Association of the ESC

Sacubitril/valsartan adherence… because the best is sometimes difficult to replace the good

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