Prognostic Implications of Diuretic Dose in Chronic Heart Failure

Abstract

Higher diuretic doses associated strongly and independently with adverse long-term outcome in chronic HF. Possibly, in euvolemic patients, efforts should be made to reduce diuretic dose.

Risk stratification in patients with cardiac resynchronisation therapy: the AL-FINE CRT risk score

“…However, a reverse association was also discussed: diuretics could worsen the HF course by activating neuroendocrine systems, renin-angiotensin-aldosterone, and renal dysfunction that together facilitate disease progression [32]. A cut-off dose of 80 mg furosemide per day to define a high and low loop diuretic dose, used for prognostic purposes in the current study, was already proposed and was associated with a worse outcome in previous studies [32][33][34]. Our study is the first to show the prognostic importance of the furosemide dose in CRT patients.…”

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

“…In a sensitivity analysis, we demonstrated that, in the medium term, the baseline diuretic dose carries a distinct prognostic value, explaining at least in part the strong association reported previously for shorter follow-up. 14,15 However, in the longer perspective, its importance decreased in favor of the time-varying dose (Appendix S1, Supplementary Table B, model 6).…”

Cardiovascular drug utilization post-implant is related to clinical outcome in heart failure patients receiving cardiac resynchronization therapy

“…An Italian study with 813 ambulatory patients with mild to moderate HF, and found that more than 50 mg furosemide daily increased the 3-year mortality [17]. A recent prospective study with 244 stable non-CRT treated HF patients also found that higher furosemide dose was associated with increased morbidity and mortality, and only 40 mg furosemide daily on top of the standard HF therapy resulted in 66% increased risk of adverse event [38]. That population was younger and had less comorbidity compared to this present one, but the medical therapy was comparable in both studies.…”

“…Loop diuretic therapy is one of the most commonly used complementary medications for symptom relief and for reducing fluid retention, but long-term data suggests potential harmful effect in higher dosages [17,38]. Early experimental studies have suggested that in HF without congestion, furosemide therapy can activate the renin-angiotensin system and thus can influence the HF negatively [39].…”