Author + information
- Hima Vidula,
- Javed Butler,
- Haris Subacius,
- Gregg Fonarow,
- Savina Nodari,
- Marvin Konstam and
- Mihai Gheorghiade
Loop diuretic use is related to the severity of cardiac and renal dysfunction in chronic heart failure (HF). The association of discharge diuretic dose and outcomes in hospitalized HF (HHF) patients is less well studied.
The Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial enrolled 4133 HHF patients with ejection fraction (EF) <40%. This analysis included 1313 patients assigned to the placebo arm and prescribed at least once daily oral loop diuretic at discharge. Weight-adjusted daily dose (WtDD) was calculated using furosemide-equivalent diuretic dose and discharge weight. Patients were followed for a median of 9.9 months for mortality and rehospitalization for HF.
The average WtDD was 1.09±1.13 mg/kg/day. Table 1shows patients’ baseline characteristics and outcomes by WtDD quartiles. Patients in the highest WtDD quartile had lower EF, glomerular filtration rate, and blood pressure, and more often diabetes. After adjustment for 24 predictors of survival, higher WtDD was associated with an increased risk of all-cause mortality (hazard ratio [HR] Q4 vs Q1 1.78, 95% confidence interval [CI] 1.25,2.55, P=0 .002) and cardiovascular mortality or rehospitalization for HF (HR Q4 vs Q1 1.36, 95% CI 1.04,1.77, P=0.023).
Higher WtDD of diuretic at dicharge is independently associated with worse outcomes among HHF patients with reduced EF. Whether this signifies a risk marker or mediator relationship needs further study.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Novel and Standard Pharmacological Therapies in Heart Failure: Which Treatment for Which Patient
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1221-291
- 2013 American College of Cardiology Foundation