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

Abstract

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.

Twelve‐year trends in pharmacologic treatment of type 2 diabetes among patients with heart failure in the United States

“…10,11 The use of loop diuretics dosage as a surrogate for HF stages was supported by prior evidence, which found higher loop diuretics dosages (≥40 mg/day) is positively associated with HF severity and consistent congestion. 10,11 F I G U R E 1 Trends in the use of antidiabetic medications among patients with concomitant type 2 diabetes and heart failure, 2006-2017. DPP-4i, dipeptidyl peptidase-4 inhibitors; GLP1, glucagon-like peptide-1 agonists; SGLT-2i, sodium-glucose co-transporter-2 inhibitors; TZDs, thiazolidinediones.…”

Impact of stroke volume on prognostic outcome in patients with atrial fibrillation and concomitant heart failure with preserved ejection fraction

“…A high-dose loop diuretic was defined as !40 mg/day of oral furosemide. The diuretic dose was converted to the furosemide equivalent dose as follows: furosemide 40 mg = azosemide 60 mg = torasemide 20 mg [16,17].…”

Diuretic dosing in heart failure: more data are needed

“…In the study by Okabe et al 1 the oral dose of 40 mg of furosemide proved being a cut-off beyond which both all-cause and cardiovascular mortality were significantly higher. The abovementioned value has been obtained using C-statistics from a total of 215 chronic heart failure (CHF) patients investigated through a median follow-up of 641 days.…”

“…In the study by Okabe et al . the oral dose of 40 mg of furosemide proved being a cut‐off beyond which both all‐cause and cardiovascular mortality were significantly higher.…”