Relation between dose of loop diuretics and outcomes in a heart failure population: Results of the ESCAPE Trial

Hasselblad, Vic; Stough, Wendy Gattis; Shah, Monica; Lokhnygina, Yuliya; O’Connor, Christopher M.; Califf, Robert M.; Adams, Kirkwood F.

doi:10.1016/j.ejheart.2007.07.011

Cited by 386 publications

(264 citation statements)

References 14 publications

Supporting

Mentioning

238

Contrasting

Unclassified

Order By: Relevance

“…20 In addition, analysis of data from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial demonstrated a strong association between diuretic dose and mortality that persisted after adjusting for differences in other mortality risk factors. 22 This analysis confirms and enhances our understanding of these diuretic effects. The risk of adverse outcomes, including death, is normally related to underlying disease severity.…”

Section: Resultssupporting

confidence: 67%

Hemodynamics, Diuretics, and Nesiritide: A Retrospective VMAC Analysis

Young

Cheng

Mills

2009

Clinical Cardiology

View full text Add to dashboard Cite

Hypothesis: Hypotension has been proposed as the cause of nesiritide-associated increases in serum creatinine (SCr); however, this hypothesis has not been tested. Methods: This retrospective evaluation of patients who had a pulmonary artery catheter and received nesiritide in the Vasodilation in the Management of Acute Congestive Heart Failure (VMAC) trial assessed hypotension, SCr elevation, concomitant therapy, and mortality. Patients were categorized by baseline pulmonary capillary wedge pressure (PCWP) and analyzed both for overall population and by diuretic dose. Results: Compared with patients with PCWP >23 mm Hg (n = 105), patients with PCWP ≤23 mm Hg (n = 49) had more hypotension within 24 hours of initiating nesiritide (16% vs 7%), but neither more SCr elevation by nominal day 30 (29% vs 28%) nor higher mortality (30 days: 8.2% vs 7.7%; 6 months: 29.0% vs 29.3%). The risk of hypotension was directly related to high dose diuretics (25% vs 6%; relative risk [RR]: 4.2; 95% confidence interval [CI]: 1.10-15.82) and was not significantly increased in patients without this concomitant treatment (10% vs 7%; RR: 1.4; 95% CI: 0.34-5.93). Additionally, high dose diuretics significantly increased the risk of SCr elevation (RR: 2.6; 95% CI: 1.03-6.64) and 6 month mortality (hazard ratio: 3.6; 95% CI: 1.19-10.63) in patients with PCWP ≤23 mm Hg. Conclusions: Hypotension is not the primary etiology for nesiritide-associated increases in SCr. High dose diuretics increase the risk of adverse outcomes in patients with PCWP ≤23 mm Hg and should be reserved for patients in whom PCWPs are known to be markedly elevated.

show abstract

Section: Resultssupporting

confidence: 67%

Hemodynamics, Diuretics, and Nesiritide: A Retrospective VMAC Analysis

Young

Cheng

Mills

2009

Clinical Cardiology

View full text Add to dashboard Cite

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

“…Furosemide treatment, especially if at high doses, has been associated with a worse prognosis [25][26][27][28] and WRF may be a potential mechanism. On the other hand, we cannot exclude the possibility that the administration of higher doses of furosemide is a consequence, rather than a cause, of more advanced HF and coexistent renal failure.…”

Section: Causes Of Wrfmentioning

confidence: 99%

Worsening renal function in patients hospitalised for acute heart failure: Clinical implications and prognostic significance

Metra

Nodari

Parrinello

et al. 2008

European J of Heart Fail

338

245

View full text Add to dashboard Cite

Background: Renal function is a powerful prognostic variable in patients with heart failure (HF). Hospitalisations for acute HF (AHF) may be associated with further worsening of renal function (WRF). Methods and results: We analysed the clinical significance of WRF in 318 consecutive patients admitted at our institute for AHF. WRF was defined as the occurrence, at any time during the hospitalisation, of both a ≥25% and a ≥ 0.3 mg/dL increase in serum creatinine (s-Cr) from admission (WRF-Abs-%). Results: Patients were followed for 480 ± 363 days. Fifty-three patients (17%) died and 132 (41%) were rehospitalised for HF. WRF-Abs-% occurred in 107 (34%) patients. At multivariable survival analysis, WRF-Abs-% was an independent predictor of death or HF rehospitalisation (adjusted HR, 1.47; 95%CI, 1.13-1.81; p = 0.024). The independent predictors of WRF-Abs-%, evaluated using multivariable logistic regression, were history of chronic kidney disease (p = 0.002), LV ejection fraction (p = 0.012), furosemide daily dose (p = 0.03) and NYHA class (p = 0.05) on admission. Conclusion: WRF is a frequent finding in patients hospitalised for AHF and is associated with a poor prognosis. Severity of HF and daily furosemide dose are the most important predictors of the occurrence of WRF.

show abstract

Relation between dose of loop diuretics and outcomes in a heart failure population: Results of the ESCAPE Trial

Cited by 386 publications

References 14 publications

Hemodynamics, Diuretics, and Nesiritide: A Retrospective VMAC Analysis

Hemodynamics, Diuretics, and Nesiritide: A Retrospective VMAC Analysis

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

Worsening renal function in patients hospitalised for acute heart failure: Clinical implications and prognostic significance

Contact Info

Product

Resources

About