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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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| Published in: | Clinical research in cardiology 2021-08, Vol.110 (8), p.1221-1233 |
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| creator | 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 |
| description | 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
|
| doi_str_mv | 10.1007/s00392-020-01779-7 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2463110726</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2463110726</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-27325e884920ac96c01141ecf22d52871775ce8843744ff81db217adebb8551b3</originalsourceid><addsrcrecordid>eNp9kc1O3TAQha2qVaG0L9BFZambbkI9dhwn3VVXUK4EYgNry3GcG6Mkk9qOEG_TR60vl4LUBSv_nG_OjH0I-QzsFBhT3yNjouEF46xgoFRTqDfkGOoKClY1_O3zvi6PyIcY7xiTwET5nhwJwaEC1RyTP9s5uTn63luTPM4Ue7oMJkzG4oi7fDvSzlmcdy4-6u2a6IyJpsFRY9O6140fH-iIuNDOr8Elb2mH0dEluM7bFOk9hny0Q8A5a4MzIdE-V2WY4posTu4H9XmM3ZDpPuBEb7ZXZ8Xm4vwjedebMbpPT-sJuT0_u9lcFJfXv7abn5eFFUqmgivBpavrsuHM2KayDKAEZ3vOO8lrlf9H2r0uVFn2fQ1dy0GZzrVtLSW04oR8O_guAX-v-bF68tG6cTSzwzVqXlYCgCleZfTrf-gdrmHO02kupVQ1VJXIFD9QNmCMwfV6CX4y4UED0_v89CE_nfPTj_lplYu-PFmv7eS655J_gWVAHICYpRxKeOn9iu1fVkenfw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2555781663</pqid></control><display><type>article</type><title>Intensification of pharmacological decongestion but not the actual daily loop diuretic dose predicts worse chronic heart failure outcome: insights from TIME-CHF</title><source>Springer Nature</source><creator>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</creator><creatorcontrib>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</creatorcontrib><description>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
< 0.001] and HF hospitalisation-free survival [HR 1.09, 95% CI (1.02–1.17),
p
= 0.015]. CCI at month 6 was independently associated with HF hospitalisation-free survival [HR 1.24, 95% CI (1.11–1.38),
p
< 0.001]. Treatment intensification was independently associated with survival [HR 1.75, 95% CI (1.19–1.38),
p
= 0.004] and HF hospitalisation-free survival [HR 1.69, 95% CI (1.22–2.35),
p
= 0.002]. Patients undergoing treatment intensification resulting in decongestion had better outcome than patients with persistent (worsening) congestion despite LD dose up-titration (
p
< 0.001).
Conclusion
Intensification of pharmacological decongestion but not the actual LD dose was related to poor outcome in chronic HF. If treatment intensification translated into clinical decongestion, outcome was better than in case of persistent or worsening congestion.
Graphic abstract</description><identifier>ISSN: 1861-0684</identifier><identifier>EISSN: 1861-0692</identifier><identifier>DOI: 10.1007/s00392-020-01779-7</identifier><identifier>PMID: 33216179</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>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</subject><ispartof>Clinical research in cardiology, 2021-08, Vol.110 (8), p.1221-1233</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020</rights><rights>2020. Springer-Verlag GmbH Germany, part of Springer Nature.</rights><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-27325e884920ac96c01141ecf22d52871775ce8843744ff81db217adebb8551b3</citedby><cites>FETCH-LOGICAL-c375t-27325e884920ac96c01141ecf22d52871775ce8843744ff81db217adebb8551b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33216179$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Simonavičius, Justas</creatorcontrib><creatorcontrib>Maeder, Micha T.</creatorcontrib><creatorcontrib>Eurlings, Casper G. M. J.</creatorcontrib><creatorcontrib>Aizpurua, Arantxa Barandiarán</creatorcontrib><creatorcontrib>Čelutkienė, Jelena</creatorcontrib><creatorcontrib>Barysienė, Jūratė</creatorcontrib><creatorcontrib>Toggweiler, Stefan</creatorcontrib><creatorcontrib>Kaufmann, Beat A.</creatorcontrib><creatorcontrib>Brunner-La Rocca, Hans-Peter</creatorcontrib><title>Intensification of pharmacological decongestion but not the actual daily loop diuretic dose predicts worse chronic heart failure outcome: insights from TIME-CHF</title><title>Clinical research in cardiology</title><addtitle>Clin Res Cardiol</addtitle><addtitle>Clin Res Cardiol</addtitle><description>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
< 0.001] and HF hospitalisation-free survival [HR 1.09, 95% CI (1.02–1.17),
p
= 0.015]. CCI at month 6 was independently associated with HF hospitalisation-free survival [HR 1.24, 95% CI (1.11–1.38),
p
< 0.001]. Treatment intensification was independently associated with survival [HR 1.75, 95% CI (1.19–1.38),
p
= 0.004] and HF hospitalisation-free survival [HR 1.69, 95% CI (1.22–2.35),
p
= 0.002]. Patients undergoing treatment intensification resulting in decongestion had better outcome than patients with persistent (worsening) congestion despite LD dose up-titration (
p
< 0.001).
Conclusion
Intensification of pharmacological decongestion but not the actual LD dose was related to poor outcome in chronic HF. If treatment intensification translated into clinical decongestion, outcome was better than in case of persistent or worsening congestion.
Graphic abstract</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Amplification</subject><subject>Cardiology</subject><subject>Chronic Disease</subject><subject>Confidence intervals</subject><subject>Congestion</subject><subject>Congestive heart failure</subject><subject>Disease Progression</subject><subject>Diuretics</subject><subject>Dosage</subject><subject>Female</subject><subject>Furosemide</subject><subject>Furosemide - administration & dosage</subject><subject>Germany</subject><subject>Heart failure</subject><subject>Heart Failure - drug therapy</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Paper</subject><subject>Patients</subject><subject>Pharmacology</subject><subject>Sodium Potassium Chloride Symporter Inhibitors - administration & dosage</subject><subject>Survival</subject><subject>Switzerland</subject><subject>Thiazides - administration & dosage</subject><subject>Titration</subject><issn>1861-0684</issn><issn>1861-0692</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kc1O3TAQha2qVaG0L9BFZambbkI9dhwn3VVXUK4EYgNry3GcG6Mkk9qOEG_TR60vl4LUBSv_nG_OjH0I-QzsFBhT3yNjouEF46xgoFRTqDfkGOoKClY1_O3zvi6PyIcY7xiTwET5nhwJwaEC1RyTP9s5uTn63luTPM4Ue7oMJkzG4oi7fDvSzlmcdy4-6u2a6IyJpsFRY9O6140fH-iIuNDOr8Elb2mH0dEluM7bFOk9hny0Q8A5a4MzIdE-V2WY4posTu4H9XmM3ZDpPuBEb7ZXZ8Xm4vwjedebMbpPT-sJuT0_u9lcFJfXv7abn5eFFUqmgivBpavrsuHM2KayDKAEZ3vOO8lrlf9H2r0uVFn2fQ1dy0GZzrVtLSW04oR8O_guAX-v-bF68tG6cTSzwzVqXlYCgCleZfTrf-gdrmHO02kupVQ1VJXIFD9QNmCMwfV6CX4y4UED0_v89CE_nfPTj_lplYu-PFmv7eS655J_gWVAHICYpRxKeOn9iu1fVkenfw</recordid><startdate>20210801</startdate><enddate>20210801</enddate><creator>Simonavičius, Justas</creator><creator>Maeder, Micha T.</creator><creator>Eurlings, Casper G. M. J.</creator><creator>Aizpurua, Arantxa Barandiarán</creator><creator>Čelutkienė, Jelena</creator><creator>Barysienė, Jūratė</creator><creator>Toggweiler, Stefan</creator><creator>Kaufmann, Beat A.</creator><creator>Brunner-La Rocca, Hans-Peter</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20210801</creationdate><title>Intensification of pharmacological decongestion but not the actual daily loop diuretic dose predicts worse chronic heart failure outcome: insights from TIME-CHF</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-27325e884920ac96c01141ecf22d52871775ce8843744ff81db217adebb8551b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Amplification</topic><topic>Cardiology</topic><topic>Chronic Disease</topic><topic>Confidence intervals</topic><topic>Congestion</topic><topic>Congestive heart failure</topic><topic>Disease Progression</topic><topic>Diuretics</topic><topic>Dosage</topic><topic>Female</topic><topic>Furosemide</topic><topic>Furosemide - administration & dosage</topic><topic>Germany</topic><topic>Heart failure</topic><topic>Heart Failure - drug therapy</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Paper</topic><topic>Patients</topic><topic>Pharmacology</topic><topic>Sodium Potassium Chloride Symporter Inhibitors - administration & dosage</topic><topic>Survival</topic><topic>Switzerland</topic><topic>Thiazides - administration & dosage</topic><topic>Titration</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Simonavičius, Justas</creatorcontrib><creatorcontrib>Maeder, Micha T.</creatorcontrib><creatorcontrib>Eurlings, Casper G. M. J.</creatorcontrib><creatorcontrib>Aizpurua, Arantxa Barandiarán</creatorcontrib><creatorcontrib>Čelutkienė, Jelena</creatorcontrib><creatorcontrib>Barysienė, Jūratė</creatorcontrib><creatorcontrib>Toggweiler, Stefan</creatorcontrib><creatorcontrib>Kaufmann, Beat A.</creatorcontrib><creatorcontrib>Brunner-La Rocca, Hans-Peter</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest_Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical research in cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Simonavičius, Justas</au><au>Maeder, Micha T.</au><au>Eurlings, Casper G. M. J.</au><au>Aizpurua, Arantxa Barandiarán</au><au>Čelutkienė, Jelena</au><au>Barysienė, Jūratė</au><au>Toggweiler, Stefan</au><au>Kaufmann, Beat A.</au><au>Brunner-La Rocca, Hans-Peter</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intensification of pharmacological decongestion but not the actual daily loop diuretic dose predicts worse chronic heart failure outcome: insights from TIME-CHF</atitle><jtitle>Clinical research in cardiology</jtitle><stitle>Clin Res Cardiol</stitle><addtitle>Clin Res Cardiol</addtitle><date>2021-08-01</date><risdate>2021</risdate><volume>110</volume><issue>8</issue><spage>1221</spage><epage>1233</epage><pages>1221-1233</pages><issn>1861-0684</issn><eissn>1861-0692</eissn><abstract>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
< 0.001] and HF hospitalisation-free survival [HR 1.09, 95% CI (1.02–1.17),
p
= 0.015]. CCI at month 6 was independently associated with HF hospitalisation-free survival [HR 1.24, 95% CI (1.11–1.38),
p
< 0.001]. Treatment intensification was independently associated with survival [HR 1.75, 95% CI (1.19–1.38),
p
= 0.004] and HF hospitalisation-free survival [HR 1.69, 95% CI (1.22–2.35),
p
= 0.002]. Patients undergoing treatment intensification resulting in decongestion had better outcome than patients with persistent (worsening) congestion despite LD dose up-titration (
p
< 0.001).
Conclusion
Intensification of pharmacological decongestion but not the actual LD dose was related to poor outcome in chronic HF. If treatment intensification translated into clinical decongestion, outcome was better than in case of persistent or worsening congestion.
Graphic abstract</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>33216179</pmid><doi>10.1007/s00392-020-01779-7</doi><tpages>13</tpages></addata></record> |
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| ispartof | Clinical research in cardiology, 2021-08, Vol.110 (8), p.1221-1233 |
| issn | 1861-0684 1861-0692 |
| language | eng |
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| source | Springer Nature |
| 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 |
| title | Intensification of pharmacological decongestion but not the actual daily loop diuretic dose predicts worse chronic heart failure outcome: insights from TIME-CHF |
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