Diuretic response in acute heart failure—an analysis from ASCEND-HF

• Published in: The American heart journal 2015-08, Vol.170 (2), p.313-321.e4
• Main Authors: ter Maaten, Jozine M., MD, Dunning, Allison M., MS, Valente, Mattia A.E., MD, Damman, Kevin, MD, PhD, Ezekowitz, Justin A., MBBCh, MSc, Califf, Robert M., MD, Starling, Randall C., MD, MPH, van der Meer, Peter, MD, PhD, O'Connor, Christopher M., MD, Schulte, Phillip J., PhD, Testani, Jeffrey M., MD, MTR, Hernandez, Adrian F., MD, MHS, Tang, W.H. Wilson, MD, Voors, Adriaan A., MD, PhD
• Format: Article
• Language: English
• Subjects: Acute Disease; Aged; Cardiovascular; Classification; Diabetes; Disease Progression; Diuretics; Diuretics - administration & dosage; Dose-Response Relationship, Drug; Double-Blind Method; Female; Follow-Up Studies; Furosemide - administration & dosage; Heart attacks; Heart failure; Heart Failure - drug therapy; Heart Failure - epidemiology; Heart Failure - physiopathology; Hospital Mortality - trends; Hospitalization; Humans; Incidence; Male; Middle Aged; Mortality; Patient Admission - statistics & numerical data; Retrospective Studies; Studies; Survival Rate - trends; Treatment Outcome; United States - epidemiology; Urine; Variables
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2015.05.003

Background Diuretic unresponsiveness often occurs during hospital admission for acute heart failure (AHF) and is associated with adverse outcome. This study aims to investigate determinants, clinical outcome, and the effects of nesiritide on diuretic response early after admission for AHF. Methods Diuretic response , defined as weight loss per 40 mg of furosemide or equivalent, was examined from hospital admission to 48 hours in 4,379 patients from the ASCEND-HF trial. As an additional analysis, a urinary diuretic response metric was investigated in 5,268 patients using urine volume from hospital admission to 24 hours per 40 mg of furosemide or equivalent. Results Mean diuretic response was −0.42 kg/40 mg of furosemide (interquartile range −1.0, −0.05). Poor responders had lower blood pressure, more frequent diabetes, long-term use of loop diuretics, poorer baseline renal function, and lower urine output (all P < .01). Randomized nesiritide treatment was not associated with diuretic response ( P = .987). Good diuretic response was independently associated with a significantly decreased risk of 30-day all-cause mortality or heart failure rehospitalization (odds ratio 0.44, 95% CI 0.29-0.65, highest vs lowest quintile, P < .001). Diuretic response based on urine output per 40 mg of furosemide showed similar results in terms of clinical predictors, association with outcome, and the absence of an effect of nesiritide. Conclusions Poor diuretic response early after hospital admission for AHF is associated with low blood pressure, renal impairment, low urine output, and an increased risk of death or rehospitalization early after discharge. Nesiritide had a neutral effect on diuretic response.