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Prognostic implication of outpatient loop diuretic dose intensification trajectories in patients with chronic heart
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
Outpatient oral loop diuretic dose increases in chronic heart failure patients indicate prognosis. Irreversible dose intensification worsens outcomes, while reversible intensification shows similar results to no dose increase.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- The prognostic impact of oral loop diuretic (OLD) dose intensification trajectories in chronic heart failure (CHF) patients is not well understood.
- Understanding these trajectories is crucial for managing CHF and improving patient outcomes.
Purpose of the Study:
- To investigate the relationship between outpatient oral loop diuretic (OLD) dose intensification trajectories and the prognosis of patients with chronic heart failure (CHF).
- To classify patients based on their OLD dose intensification patterns over one year and assess associated mortality and hospitalization risks.
Main Methods:
- A cohort of 832 CHF patients had their OLD dose trajectories tracked for one year.
- Patients were categorized into irreversible, reversible, or no OLD dose intensification groups.
- Outcomes assessed included all-cause mortality, cardiovascular death, heart failure hospitalization, and composite endpoints.
Main Results:
- Irreversible OLD dose intensification was linked to significantly higher risks for all studied outcomes compared to no intensification.
- Specifically, irreversible intensification showed increased hazard ratios for all-cause mortality, heart failure hospitalization, and composite cardiovascular events.
- Reversible OLD dose intensification demonstrated prognoses comparable to those with no dose intensification.
Conclusions:
- Outpatient oral loop diuretic dose intensification trajectories can effectively stratify the prognosis of chronic heart failure patients.
- The pattern of diuretic dose adjustment, particularly irreversibility, is a significant predictor of patient outcomes in CHF.
Background:
The relationship between outpatient oral loop diuretic (OLD) dose intensification trajectories and the prognosis of patients with chronic heart failure (CHF) remains unclear.
Methods:
In 832 patients with CHF, OLD dose trajectories for 1 year were consecutively investigated. OLD dose intensification was defined as the first occurrence of OLD dose increase from the baseline within the first year. Patients were classified into three groups of OLD dose intensification trajectories: irreversible, reversible, and no intensification. Irreversible intensification was defined as an OLD dose intensification wherein the dose remained above the baseline during the first year of follow-up. Reversible intensification referred to an OLD dose intensification wherein the dose returned to or dropped below the baseline within the first year of follow-up. No intensification was defined as no OLD dose intensification throughout the first year of follow-up. The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular death (CVD), heart failure hospitalisation (HFH), a composite of CVD or HFH, and a composite of all-cause mortality or HFH after 1 year.
Results:
During the median follow-up (57 [range, 13-102] months), 146 patients died. Irreversible intensification was associated with higher risks of all outcomes than no intensification (e.g., all-cause mortality: hazard ratio [HR], 1.63; 95% confidence interval [CI], 1.08-2.44; HFH: HR, 2.16; 95% CI, 1.65-2.98; CVD or HFH: HR, 2.17; 95% CI, 1.59-2.96). Conversely, reversible intensification had comparable prognoses for all outcomes to no intensification.
Conclusion:
OLD dose intensification trajectories could stratify the prognosis of CHF patients.
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