Dose of furosemide before admission predicts diuretic efficiency and long‐term prognosis in acute heart failure

Abstract

Aims The outpatient diuretic dose is a marker of diuretic resistance and prognosis in chronic heart failure (HF). Still, the impact of the preadmission dose on diuretic efficiency (DE) and prognosis in acute HF is not fully known. Methods and results We conducted an observational and prospective study. All patients admitted for acute HF treated with intravenous diuretic and at least one criterion of congestion on admission were evaluated. Decongestion [physical examination, hemoconcentration, N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) change, and lung ultrasound], DE (weight loss and urine output per unit of 40 mg furosemide), and urinary sodium were monitored on the fifth day of admission. DE was dichotomized into high–low based on the median value. A multivariate Cox regression analysis was conducted to find predictors of HF readmission or mortality. A total of 105 patients were included between July 2017 and July 2019. Mean age was 74.5 ± 12.0 years, 64.8% were male, 33.3% had de novo HF, and mean left ventricular ejection fraction was 46 ± 17%. Median follow‐up was 26 [15–35] months. Low DE based on weight loss was associated with a higher previous dose of furosemide (odds ratio [OR] 1.01 [1.00–1.02]), thiazide treatment before admission (OR 9.37 [2.19–40.14]), and lower diastolic blood pressure (OR 0.95 [0.91–0.98]) in the multivariate regression model. Only previous dose of furosemide (OR 1.01 [1.00–1.02]) and haemoglobin at admission (OR 0.76 [0.58–0.99]) were associated with low DE based on urine output in the multivariate analysis. The correlation between the previous dose of furosemide and DE based on weight loss was poor (r = −0.12; P = 0.209) and with DE based on urine output was weak to moderate (r = −0.33; P < 0.001). Low DE based on weight loss and urine output was associated with lesser decongestion measured by NT‐proBNP (P = 0.011; P = 0.007), hemoconcentration (P = 0.006; P = 0.044), and lung ultrasound (P = 0.034; P = 0.029), but not by physical examination (P = 0.506; P = 0.560). Survival and event‐free survival in acute decompensated HF (ADHF) were lower than in de novo HF; a preadmission dose of furosemide > 80 mg in ADHF identified patients with particularly poor prognosis (log‐rank < 0.001). In ADHF, the preadmission dose of furosemide (hazard ratio [HR] 1.34 [1.08–1.67] per 40 mg) and NT‐proBNP at admission (HR 1.03 [1.01–1.06] per 1000 pg/mL) were independently associated with mortality or HF readmission in the multivariate Cox regression analysis. Conclusions The outpatient dose of furosemide before acute HF admission predicts DE and must be taken into account when deciding on the initial diuretic dose. In ADHF, the outpatient dose of furosemide can predict long‐term prognosis better than DE during hospitalization.

Combining loop with thiazide diuretics for decompensated heart failure: the CLOROTIC trial

“…Forth, the patients who participated in the trial had a history of chronic HF and required moderate-to-high doses of loop diuretics before admission (which is the case for 20-30% of patients with chronic HF who are admitted due to decompensation). 24,25 Our findings may not be applicable to patients with newly diagnosed HF or those with more modest diuretic requirements. Finally, in the followup visits, neither renal function nor electrolytes were monitored, so we cannot guarantee that the worsening of renal function is transient and associated with a good diuretic response.…”

Pre-Discharge Urinary Albumin-Creatinine Ratio as a Predictor of Post-Hospitalization Major Adverse Cardiovascular Events (MACEs) Due to Acute Heart Failure

“…A study conducted by Bermejo, Z.B, et al (2022) also found that in patients with AHF, the presence of a history of pre-admission diuretic use > 80 mg/day was associated with a worse disease prognosis (log rank < 0.001). In patients with AHF, pre-admission furosemide dose was independently associated with both mortality and rehospitalization due to HF [33].…”

Goreisan as a successful adjuvant therapy of heart failure with preserved ejection fraction and advanced chronic kidney disease: a case report

“…The water-regulating effects of Goreisan have the potential to reduce the reliance on conventional loop diuretics and aid in preserving renal function, which were associated with poor prognosis in HFpEF patients [ 9 ]. Moreover, Goreisan has pleiotropic effects in cardiomyocytes where aquaporin 1, 4, and 7 are expressed, as it has been shown to suppress the upregulation of aquaporin 4 gene expression [ 5 , 10 ].…”