Increased dose of diuretics correlates with severity of heart
failure and renal dysfunction and does not lead to reduction of
mortality and rehospitalizations due to acute decompensation of
heart failure; data from AHEAD registry

J 2018

Increased dose of diuretics correlates with severity of heart failure and renal dysfunction and does not lead to reduction of mortality and rehospitalizations due to acute decompensation of heart failure; data from AHEAD registry

PAVLUŠOVÁ, Marie, Roman MIKLÍK, Radim SPACEK, Klára BENEŠOVÁ, Karel ZEMAN et. al.

Basic information

Original name

Increased dose of diuretics correlates with severity of heart failure and renal dysfunction and does not lead to reduction of mortality and rehospitalizations due to acute decompensation of heart failure; data from AHEAD registry

Authors

PAVLUŠOVÁ, Marie (203 Czech Republic, belonging to the institution), Roman MIKLÍK (203 Czech Republic, belonging to the institution), Radim SPACEK (203 Czech Republic), Klára BENEŠOVÁ (203 Czech Republic, belonging to the institution), Karel ZEMAN (203 Czech Republic), Alain COHEN-SOLAL (250 France), Alexandre MEBAZAA (250 France), Simona LITTNEROVÁ (203 Czech Republic, belonging to the institution), Marián FELŠŐCI (703 Slovakia), Lidka POHLUDKOVA (203 Czech Republic), Ladislav DUŠEK (203 Czech Republic, belonging to the institution), Lenka ŠPINAROVÁ (203 Czech Republic), Jiří VÍTOVEC (203 Czech Republic), Jindřich ŠPINAR (203 Czech Republic, belonging to the institution), Jiří JARKOVSKÝ (203 Czech Republic, guarantor, belonging to the institution) and Jiří PAŘENICA (203 Czech Republic, belonging to the institution)

Edition

cor et Vasa, AMSTERDAM, ELSEVIER SCIENCE BV, 2018, 0010-8650

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

Netherlands

Confidentiality degree

není předmětem státního či obchodního tajemství

RIV identification code

RIV/00216224:14110/18:00104145

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1016/j.crvasa.2017.09.007

UT WoS

000433252900002

Keywords in English

Acute heart failure; Rehospitalization; AHEAD; Mortality; Diuretic; Furosemide

Abstract

V originále

Background: Diuretics are being used to reduce symptoms of congestion and fluid retention in heart failure patients but their effect has not been studied in randomized clinical trials. The data about positive or negative effect of loop diuretics depending on their dose is conflicting and controversial. The aim of this analysis is to evaluate whether the relatively small increase in the dose of furosemide can reduce the incidence of readmissions for acute heart failure decompensation and/or total mortality. Methods and results: We evaluated a total of 1119 patients admitted for ADHF who were discharged from the hospital back home in a stable condition. All surviving patients were followed up for at least two years. The primary endpoint was a combination of hospital readmissions for acute heart failure and overall mortality. The primary analysis showed significantly different characteristics and prognosis of patients who did not require any loop diuretic and those requiring furosemide dose >125 mg. Therefore, we compared a group of patients with low-dose furosemide (10-40 mg) with a group of patients with high-dose furosemide (41-125 mg) only. The higher dose of diuretics correlated well with disease severity (lower systolic blood pressure, more frequent chronic exertional dyspnea NYHA III, lower left ventricular ejection fraction, increased creatinine levels). Long-term mortality and the number of rehospitalizations were lower in the low-dose diuretic group (p = 0.037 and p = 0.036, respectively) but after adjustment using the propensity score matching the incidence of the primary endpoint was comparable in both groups. Conclusion: The dose of a loop diuretic recommended to patients with acute heart failure at hospital discharge correlates well with the severity of heart failure. When comparing the groups of patients with a higher dose of furosemide (41-125 mg) and a lower dose of furosemide (10-40 mg) we found that after adjustment using propensity score matching the higher dose of loop diuretic had a neutral effect on the incidence of the composite endpoint of overall mortality and/or readmission for ADHF. (C) 2017 The Czech Society of Cardiology. Published by Elsevier Sp. z o.o. All rights reserved.

Links

MUNI/A/1363/2016, interní kód MU

Name: Validace Rule-out/rule-in protokolu u pacientů s bolestí na hrudi - prospektivní studie

Investor: Masaryk University, Category A

Citovat

PAVLUŠOVÁ, Marie, Roman MIKLÍK, Radim SPACEK, Klára BENEŠOVÁ, Karel ZEMAN, Alain COHEN-SOLAL, Alexandre MEBAZAA, Simona LITTNEROVÁ, Marián FELŠŐCI, Lidka POHLUDKOVA, Ladislav DUŠEK, Lenka ŠPINAROVÁ, Jiří VÍTOVEC, Jindřich ŠPINAR, Jiří JARKOVSKÝ and Jiří PAŘENICA. Increased dose of diuretics correlates with severity of heart failure and renal dysfunction and does not lead to reduction of mortality and rehospitalizations due to acute decompensation of heart failure; data from AHEAD registry. cor et Vasa. AMSTERDAM: ELSEVIER SCIENCE BV, 2018, vol. 60, No 3, p. "E215"-"E223", 9 pp. ISSN 0010-8650. Available from: https://dx.doi.org/10.1016/j.crvasa.2017.09.007.

@article{1453796,
   author = {Pavlušová, Marie and Miklík, Roman and Spacek, Radim and Benešová, Klára and Zeman, Karel and CohenandSolal, Alain and Mebazaa, Alexandre and Littnerová, Simona and Felšőci, Marián and Pohludkova, Lidka and Dušek, Ladislav and Špinarová, Lenka and Vítovec, Jiří and Špinar, Jindřich and Jarkovský, Jiří and Pařenica, Jiří},
   article_location = {AMSTERDAM},
   article_number = {3},
   doi = {http://dx.doi.org/10.1016/j.crvasa.2017.09.007},
   keywords = {Acute heart failure; Rehospitalization; AHEAD; Mortality; Diuretic; Furosemide},
   language = {eng},
   issn = {0010-8650},
   journal = {cor et Vasa},
   title = {Increased dose of diuretics correlates with severity of heart failure and renal dysfunction and does not lead to reduction of mortality and rehospitalizations due to acute decompensation of heart failure; data from AHEAD registry},
   volume = {60},
   year = {2018}
}

TY  - JOUR
ID  - 1453796
AU  - Pavlušová, Marie - Miklík, Roman - Spacek, Radim - Benešová, Klára - Zeman, Karel - Cohen-Solal, Alain - Mebazaa, Alexandre - Littnerová, Simona - Felšőci, Marián - Pohludkova, Lidka - Dušek, Ladislav - Špinarová, Lenka - Vítovec, Jiří - Špinar, Jindřich - Jarkovský, Jiří - Pařenica, Jiří
PY  - 2018
TI  - Increased dose of diuretics correlates with severity of heart failure and renal dysfunction and does not lead to reduction of mortality and rehospitalizations due to acute decompensation of heart failure; data from AHEAD registry
JF  - cor et Vasa
VL  - 60
IS  - 3
SP  - "E215"-"E223"
EP  - "E215"-"E223"
PB  - ELSEVIER SCIENCE BV
SN  - 00108650
KW  - Acute heart failure
KW  - Rehospitalization
KW  - AHEAD
KW  - Mortality
KW  - Diuretic
KW  - Furosemide
N2  - Background: Diuretics are being used to reduce symptoms of congestion and fluid retention in heart failure patients but their effect has not been studied in randomized clinical trials. The data about positive or negative effect of loop diuretics depending on their dose is conflicting and controversial. The aim of this analysis is to evaluate whether the relatively small increase in the dose of furosemide can reduce the incidence of readmissions for acute heart failure decompensation and/or total mortality. Methods and results: We evaluated a total of 1119 patients admitted for ADHF who were discharged from the hospital back home in a stable condition. All surviving patients were followed up for at least two years. The primary endpoint was a combination of hospital readmissions for acute heart failure and overall mortality. The primary analysis showed significantly different characteristics and prognosis of patients who did not require any loop diuretic and those requiring furosemide dose >125 mg. Therefore, we compared a group of patients with low-dose furosemide (10-40 mg) with a group of patients with high-dose furosemide (41-125 mg) only. The higher dose of diuretics correlated well with disease severity (lower systolic blood pressure, more frequent chronic exertional dyspnea NYHA III, lower left ventricular ejection fraction, increased creatinine levels). Long-term mortality and the number of rehospitalizations were lower in the low-dose diuretic group (p = 0.037 and p = 0.036, respectively) but after adjustment using the propensity score matching the incidence of the primary endpoint was comparable in both groups. Conclusion: The dose of a loop diuretic recommended to patients with acute heart failure at hospital discharge correlates well with the severity of heart failure. When comparing the groups of patients with a higher dose of furosemide (41-125 mg) and a lower dose of furosemide (10-40 mg) we found that after adjustment using propensity score matching the higher dose of loop diuretic had a neutral effect on the incidence of the composite endpoint of overall mortality and/or readmission for ADHF. (C) 2017 The Czech Society of Cardiology. Published by Elsevier Sp. z o.o. All rights reserved.
ER  -

PAVLUŠOVÁ, Marie, Roman MIKLÍK, Radim SPACEK, Klára BENEŠOVÁ, Karel ZEMAN, Alain COHEN-SOLAL, Alexandre MEBAZAA, Simona LITTNEROVÁ, Marián FELŠ$\backslash$H OCI, Lidka POHLUDKOVA, Ladislav DUŠEK, Lenka ŠPINAROVÁ, Jiří VÍTOVEC, Jindřich ŠPINAR, Jiří JARKOVSKÝ and Jiří PAŘENICA. Increased dose of diuretics correlates with severity of heart failure and renal dysfunction and does not lead to reduction of mortality and rehospitalizations due to acute decompensation of heart failure; data from AHEAD registry. \textit{cor et Vasa}. AMSTERDAM: ELSEVIER SCIENCE BV, 2018, vol.~60, No~3, p.~''E215''-''E223'', 9 pp. ISSN~0010-8650. Available from: https://dx.doi.org/10.1016/j.crvasa.2017.09.007.

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