Intensification of pharmacological decongestion but not the actual daily loop diuretic dose predicts worse chronic heart failure outcome: insights from TIME-CHF

Background Both loop diuretics (LDs) and congestion have been related to worse heart failure (HF) outcome. The relationship between the cause and effect is unknown. The aim of this study was to investigate the interaction between congestion, diuretic use and HF outcome. Methods Six hundred and twent...

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Bibliographic Details
Published in:Clinical research in cardiology 2021-08, Vol.110 (8), p.1221-1233
Main Authors: Simonavičius, Justas, Maeder, Micha T., Eurlings, Casper G. M. J., Aizpurua, Arantxa Barandiarán, Čelutkienė, Jelena, Barysienė, Jūratė, Toggweiler, Stefan, Kaufmann, Beat A., Brunner-La Rocca, Hans-Peter
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Amplification
Cardiology
Chronic Disease
Confidence intervals
Congestion
Congestive heart failure
Disease Progression
Diuretics
Dosage
Female
Furosemide
Furosemide - administration & dosage
Germany
Heart failure
Heart Failure - drug therapy
Humans
Male
Medicine
Medicine & Public Health
Original Paper
Patients
Pharmacology
Sodium Potassium Chloride Symporter Inhibitors - administration & dosage
Survival
Switzerland
Thiazides - administration & dosage
Titration
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Summary:Background Both loop diuretics (LDs) and congestion have been related to worse heart failure (HF) outcome. The relationship between the cause and effect is unknown. The aim of this study was to investigate the interaction between congestion, diuretic use and HF outcome. Methods Six hundred and twenty-two chronic HF patients from TIME-CHF were studied. Congestion was measured by means of a clinical congestion index (CCI). Loop diuretic dose was considered at baseline and month 6. Treatment intensification was defined as the increase in LD dose over 6 months or loop diuretic and thiazide or thiazide-like diuretic co-administration. The end-points were survival and HF hospitalisation-free survival. Results High-LD dose at baseline and month 6 (≥ 80 mg of furosemide per day) was not identified as an independent predictor of outcome. CCI at baseline remained independently associated with impaired survival [hazard ratio (HR) 1.34, (95% confidence interval) (95% CI) (1.20–1.50), p  
ISSN:1861-0684
1861-0692
DOI:10.1007/s00392-020-01779-7