Relation of Loop Diuretic Dose to Mortality in Advanced Heart Failure

Eshaghian, Shervin; Horwich, Tamara B.; Fonarow, Gregg C.

doi:10.1016/j.amjcard.2005.12.072

Cited by 355 publications

(260 citation statements)

References 23 publications

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“…The study showed a stepwise, dose-dependent effect of loops on mortality. 16 Another retrospective study evaluating the relationship of loop diuretic and angiotensin-converting enzyme (ACE) inhibitor doses with total and cause-specific mortality found similar results. High diuretic doses were independently associated with mortality, sudden death, and pump failure death.…”

Section: Clinical Studies In Heart Failurementioning

confidence: 90%

Loop Diuretic Therapy in Heart Failure: The Need for Solid Evidence on a Fluid Issue

Chiong

Cheung

2010

Clinical Cardiology

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BackgroundHeart failure (HF) is a common condition associated with substantial cost, morbidity, and mortality. Because results of clinical trials in the acute decompensated heart failure (ADHF) setting have been mostly neutral, loop diuretics remain the mainstay of treatment.HypothesisLoop diuretic use may be associated with unfavorable outcomes.MethodsA MEDLINE literature search was performed to identify articles relating to heart failure and loop diuretics. The current evidence on the risks and benefits of loop diuretics for the treatment of ADHF is reviewed.ResultsLoop diuretics are associated with symptomatic improvements in congestion, urine output, and body weight, but have shown no long‐term mortality benefit. Loop diuretics, especially at high doses, are associated with worsened renal function and other poor outcomes.ConclusionsLoop diuretics still prove useful in HF treatment, but risk‐benefit analysis of these agents in the treatment of ADHF requires a well‐designed prospective study. Copyright © 2010 Wiley Periodicals, Inc.

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Section: Clinical Studies In Heart Failurementioning

confidence: 90%

Loop Diuretic Therapy in Heart Failure: The Need for Solid Evidence on a Fluid Issue

Chiong

Cheung

2010

Clinical Cardiology

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“…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

347

251

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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.

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“…Compared with patients in the first quartile of diuretic dose, patients in the second, third, and fourth quartiles had 2-year adjusted mortality hazard ratios of 1.2 (95% CI: 0.6-2.5), 2.6 (95% CI: 1.3-5.2), and 4.0 (95% CI: 1.9-8.4), respectively, in a large, single institution study. 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.…”

Section: Resultsmentioning

confidence: 99%

Hemodynamics, Diuretics, and Nesiritide: A Retrospective VMAC Analysis

Young

Cheng

Mills

2009

Clinical Cardiology

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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.

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Relation of Loop Diuretic Dose to Mortality in Advanced Heart Failure

Cited by 355 publications

References 23 publications

Loop Diuretic Therapy in Heart Failure: The Need for Solid Evidence on a Fluid Issue

Loop Diuretic Therapy in Heart Failure: The Need for Solid Evidence on a Fluid Issue

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

Hemodynamics, Diuretics, and Nesiritide: A Retrospective VMAC Analysis

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