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Use of loop diuretics in patients with chronic heart failure: an observational overview
Niels Tb Scholte1, Dilan Aydin1, Gerard Cm Linssen2
1Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
Insights
Loop diuretic use is common in heart failure (HF), especially for patients with reduced ejection fraction (EF). Higher diuretic doses are linked to advanced HF symptoms, diabetes, and kidney issues across all EF types.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Loop diuretics (LDs) are standard treatments for heart failure (HF).
- Understanding LD use and dosage across the ejection fraction (EF) spectrum is crucial for optimizing HF management.
- Real-world data on LD utilization in diverse HF populations remain essential.
Purpose of the Study:
- To evaluate the utilization and dosage of loop diuretics (LDs) in a large cohort of chronic heart failure (HF) patients.
- To analyze LD use and dose across the entire ejection fraction (EF) spectrum.
- To identify clinical factors associated with higher LD doses in HF patients.
Main Methods:
- Analysis of 10,366 chronic HF patients from 34 Dutch outpatient clinics.
- Stratification of daily diuretic dose by furosemide dose equivalent (FDE) >80 mg or ≤80 mg.
- Multivariable logistic regression to determine associations between diuretic dose and clinical features.
Main Results:
- 82.1% of HF patients used diuretics, with 96.1% of those using LDs.
- LD use was highest in HF with reduced EF (HFrEF) (81.1%) compared to HF with preserved EF (73.8%).
- Median FDE was 40 mg; NYHA classes III-IV, diabetes mellitus, and renal impairment were associated with higher FDE (>80 mg) across all EF categories.
Conclusions:
- Loop diuretic use is prevalent in chronic heart failure, particularly in HFrEF.
- Higher diuretic doses are significantly associated with advanced HF symptoms, diabetes mellitus, and impaired renal function, irrespective of EF.
- These findings highlight the need for tailored diuretic management strategies in HF patients.
Introduction:
This study aimed to evaluate the use and dose of loop diuretics (LDs) across the entire ejection fraction (EF) spectrum in a large, 'real-world' cohort of chronic heart failure (HF) patients.
Methods:
A total of 10 366 patients with chronic HF from 34 Dutch outpatient HF clinics were analysed regarding diuretic use and diuretic dose. Data regarding daily diuretic dose were stratified by furosemide dose equivalent (FDE)>80 mg or ≤80 mg. Multivariable logistic regression models were used to assess the association between diuretic dose and clinical features.
Results:
In this cohort, 8512 (82.1%) patients used diuretics, of which 8179 (96.1%) used LDs. LD use was highest among HF with reduced EF (HFrEF) patients (81.1%) followed by HF with mild-reduced EF (76.1%) and HF with preserved ejection fraction EF (73.8%, p<0.001). Among all LDs users, the median FDE was 40 mg (IQR: 40-80). The results of the multivariable analysis showed that New York Heart Association classes III and IV and diabetes mellitus were one of the strongest determinants of an FDE >80 mg, across all HF categories. Renal impairment was associated with a higher FDE across the entire EF spectrum.
Conclusion:
In this large registry of real-world HF patients, LD use was highest among HFrEF patients. Advanced symptoms, diabetes mellitus and worse renal function were significantly associated with a higher diuretic dose regardless of left ventricular ejection fraction.
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