Clinical effects of combined treatment by optimal dose of furosemide and spironolactone on diastolic heart failure in elderly patients

Abstract

Diastolic heart failure (DHF) is characterized by symptoms including reduced ventricular relaxation and compliance, resulting in congestion of pulmonary and systemic circulation. The curative effects of regular cardiac agents are ineffective. Thus, new agents are required to treat chronic cardiac failure. The aim of the present study was to examine the clinical effects of the combined treatment by optimal dose of furosemide (20 mg/day) and spironolactone (40 mg/day) on elderly patients with diastolic heart failure (DHF) [New York Heart Association (NYHA) 1–2 grade]. A total of 93 patients diagnosed with DHF between February, 2013 and February, 2014 were enrolled in the present study. The patients were randomly divided into the furosemide group (20 mg/day, n=27), optimal dose group (20 mg/day furosemide+40 mg/day spirolactone, n=36), and large dose group (40 mg/day furosemide+100 mg/day spirolactone, n=30). Following treatment for one month, a comparison and analysis of the NYHA class, left ventricular ejection fraction (LVEF) and left ventricular end diastolic diameter (LVEDD), left ventricular wall segmental motion among the three groups were performed. The re-hospitalization rate of heart failure and incidence of electrolyte disorder among the three groups was compared and their differences analysed. Compared with pretreatment, the NYHA classifications of the three groups after treatment were reduced and differences were statistically significant (P<0.05). By contrast, for the NYHA classification after treatment there was no statistical significance (P>0.05). Compared with pretreatment, LVEF of the optimal dose group increased, LVEDD decreased, and the average systolic myocardial peak velocity and early diastolic myocardial peak velocity of ventricular wall motion were reduced, with differences being statistically significant (P<0.05). By contrast, in the furosemide and large dose groups no statistical significance was identified before and after the treatment (P>0.05). Improvement of the optimal dose group following treatment was more significant than the remaining two groups, and differences were statistically significant (P<0.05). The re-hospitalization rate of heart failure and incidence of electrolyte disorder in the optimal dose group following treatment were significantly less than the other two groups, and differences were statistically significant (P<0.05). In conclusion, the optimal dose (20 mg/day furosemide+40 mg/day spirolactone) significantly improved the clinical symptoms of elderly DHF patients (NYHA 1–2 grade) and ameliorated their long-term prognosis.

Polypharmacy and risk of mortality among patients with heart failure following hospitalization: a nested case–control study

“…In fact, among hydralazine users in our cohort, only 20% of them were using ACEIs or ARBs. Conversely, the positive association between spironolactone and the risk of mortality is less intuitive, given that since the mean and median (interquartile range) dose of spironolactone used was 25 mg 31 , 32 .…”

Torasemide versus furosemide in treatment of heart failure: A systematic review and meta‐analysis of randomized controlled trials

“…Loop diuretics have different impacts on the two spectrums of HF: diastolic and systolic. Little evidence of loop diuretics has been proved to be effective in diastolic HF while they are widely recommended in systolic HF. Our subgroups analysis for those two types of HF was only meaningful for weight loss outcome due to the large number of included studies.…”

Clinical Feature Classification for Chronic Heart Failure and Construction of a Safe Mechanism for Rehabilitation using Internet-of-Medical-Thing Devices

“…Diastolic HF is ascribed to the natural effect of aging on the heart. It is mainly caused by the stiffening of heart muscles, which can prevent the patient's heart from properly filling with blood [9]. Diastolic HF may not reduce the ejection fraction compared to systolic HF patients.…”