Diuretic dose trajectories in dilated cardiomyopathy: prognostic implications

Area of Science:

• Cardiology
• Pharmacology
• Heart Failure Research

Background:

• Loop diuretics (LD) and higher doses are linked to adverse prognosis in heart failure patients.
• This study focuses on LD dose trajectories and their impact on outcomes specifically in dilated cardiomyopathy (DCM) patients.

Purpose of the Study:

• To investigate loop diuretic (LD) dose trajectories in patients with dilated cardiomyopathy (DCM).
• To assess the association between LD dose patterns and adverse clinical outcomes in DCM.

Main Methods:

• Furosemide-equivalent dose (FED) at enrollment and changes over 24 months were analyzed.
• Patients were categorized into: dose increase (dose↑), dose decrease (dose↓), stable dose, and never-users.
• Primary outcome: all-cause death/heart transplantation/ventricular-assist-device/heart failure hospitalization. Secondary outcome: all-cause death/heart transplantation/ventricular-assist-device.

Main Results:

• Higher baseline FED was independently associated with adverse outcomes (HR per 20 mg increase: 1.12).
• Compared to never-users, stable dose (HR 2.42) and dose↑ (HR 2.76) groups had significantly higher risks of the primary outcome.
• Discontinuation of LD was associated with improved outcomes (HR 0.43) compared to continued LD use.

Conclusions:

• Loop diuretic (LD) use and increasing furosemide-equivalent dose (FED) are strong indicators of adverse outcomes in DCM.
• Patients with DCM who never receive LD exhibit an excellent prognosis.
• LD dose management, including discontinuation, is crucial for improving outcomes in DCM patients.