Prognostic impact of outpatient loop diuretic reduction patterns in patients with chronic heart failure
Toshiharu Koike1, Atsushi Suzuki1, Noriko Kikuchi1
1Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
Insights
Reducing oral loop diuretic doses in heart failure patients is linked to better outcomes. This study found that dose reduction, especially successive reductions, significantly lowers the risk of death and hospitalization.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Research
Background:
- The prognostic implications of outpatient oral loop diuretic (LD) dose reduction in heart failure (HF) patients are not well understood.
- Existing research has not clearly defined the relationship between LD dose modification patterns and patient outcomes.
Purpose of the Study:
- To investigate the association between different patterns of outpatient oral loop diuretic (LD) dose reduction and prognosis in patients with heart failure (HF).
- To determine if LD dose reduction serves as an indicator of prognosis in HF management.
Main Methods:
- A cohort of 679 HF patients on LDs from September 2015 to August 2019 was analyzed.
- Patients were categorized into no-reduction, single-reduction, and successive-reduction groups based on LD dose changes during follow-up.
- Primary outcomes included all-cause death, HF hospitalization (HFH), and the composite of cardiovascular death (CVD) or HFH.
Main Results:
- Over a median follow-up of 53.7 months, 156 deaths occurred.
- The LD dose reduction group showed a significantly lower risk of all-cause death (HR=0.65) and the composite of CVD or HFH (HR=0.69) compared to the no-reduction group.
- The successive-reduction group demonstrated a substantially lower risk for the composite of CVD or HFH (HR=0.26) and HFH (HR=0.34) compared to the single-reduction group.
Conclusions:
- Patterns of outpatient oral loop diuretic dose reduction are associated with prognosis in heart failure patients.
- LD dose reduction, particularly successive reductions, may serve as a valuable indicator of a favorable prognosis in HF management.
Background:
The relationship between patterns of outpatient oral loop diuretic (LD) dose reduction and prognosis in patients with heart failure (HF) remains unclear.
Methods:
We evaluated 679 patients with HF-prescribed LDs at baseline between September 2015 and August 2019. Dose reduction was defined as a change to a lower LD dose than the previous outpatient dose. Dose intensification was defined as a change to a higher LD dose than the previous outpatient dose. Patients were classified into no-reduction (no LD dose reduction during follow-up) and reduction groups (categorized into successive-reduction [≥2 successive LD dose reductions without intervening LD dose intensification] and single-reduction [LD dose reduction without successive dose reduction] groups). The primary outcomes were all-cause death, HF hospitalization (HFH), and the composite of cardiovascular death (CVD) or HFH.
Results:
Within a median follow-up of 53.7 (range, 2.6-99.1) months, 156 deaths were recorded: 121 (29 %), 31 (15 %), and three (4 %) patients in the no-reduction (n = 411), single-reduction (n = 195), and successive-reduction (n = 73) groups, respectively. After adjusting for cofounders, the reduction group had a lower risk of primary outcomes than the no reduction group (all-cause death: hazard ratio (HR) = 0.65, 95 % confidence interval (CI) = 0.44-0.96; CVD or HFH: HR=0.69, 95 %CI=0.52-0.93; HFH: HR=0.69, 95 % CI=0.52-0.93). The successive-reduction group had a lower risk of the composite of CVD or HFH (HR=0.26, 95 % CI: 0.10-0.67) and HFH (HR=0.34, 95 % CI=0.13-0.86) than the single-reduction group.
Conclusions:
Outpatient LD dose reduction patterns can be indicators of good prognosis in HF patients.
More Related Videos
Related Concept Videos
01:22Heart Failure Drugs: Diuretics
01:30Heart Failure V: Medical Management
01:22Heart Failure VI: Adjunct Therapies
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:29Heart Failure II: Pathophysiology
01:30Heart Failure IV: Classification and Diagnostic Evaluation