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Effects on survival of loop diuretic dosing in ambulatory patients with chronic heart failure using a propensity

F L Dini1, S Ghio, C Klersy

  • 1Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy. f.dini@ao-pisa.toscana.it

International Journal of Clinical Practice
|June 14, 2013
PubMed

Insights

High-dose furosemide in chronic heart failure (CHF) patients is linked to increased mortality. A daily dose exceeding 50 mg of furosemide significantly raises the risk of death in these patients.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Chronic heart failure (CHF) with left ventricular (LV) systolic dysfunction is a major cause of mortality.
  • Furosemide is a common diuretic used in CHF management, but its optimal dosing and impact on survival remain areas of investigation.
  • Understanding the relationship between furosemide dosage and patient outcomes is crucial for refining treatment strategies.

Purpose of the Study:

  • To determine if escalating oral furosemide doses correlate with reduced survival in outpatients diagnosed with CHF and LV systolic dysfunction.
  • To identify a potential threshold dose of furosemide associated with increased mortality risk.

Main Methods:

  • A cohort of 813 CHF outpatients with LV ejection fraction ≤ 45% underwent baseline echo-Doppler assessment.
  • Daily furosemide doses were recorded, and chronic kidney disease (CKD) was defined by glomerular filtration rate.
  • A Cox proportional hazards model, stratified by propensity score for furosemide use, was employed to analyze all-cause mortality over a mean follow-up of 44 months.

Main Results:

  • Mortality risk demonstrated a linear increase across quartiles of furosemide dosage after propensity score stratification (HR 1.38).
  • A daily furosemide dose of 50 mg emerged as a significant threshold, predicting a higher risk of death within 3 years (AUC 0.68).
  • Increased furosemide doses were associated with elevated mortality risk irrespective of LV filling patterns, CKD status, or concomitant ACE-inhibitor/beta-blocker therapy.

Conclusions:

  • In CHF outpatients, higher daily furosemide doses are linearly associated with increased all-cause mortality.
  • A furosemide threshold of 50 mg daily appears to be linked to poorer survival outcomes in this patient population.
Abstract

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