Journal
EUROPEAN HEART JOURNAL
Volume 40, Issue 44, Pages 3605-3612Publisher
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehz554
Keywords
Heart failure; Furosemide; Dyspnoea
Categories
Funding
- Instituto de Avaliacao em Tecnologia em Saude (IATS)
- National Council for Scientific and Technological Development (CNPq, Brazil) [467110/2014-0]
- CNPq [310679/2016-8, 30833/2017-1]
- FAPEMIG [PPM-00428-17]
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Aims Although loop diuretics are widely used to treat heart failure (HF), there is scarce contemporary data to guide diuretic adjustments in the outpatient setting. Methods and results In a prospective, randomized and double-blind protocol, we tested the safety and tolerability of withdrawing low-dose furosemide in stable HF outpatients at 11 HF clinics in Brazil. The trial had two blindly adjudicated co-primary outcomes: (i) symptoms assessment quantified as the area under the curve (AUC) of a dyspnoea score on a visual-analogue scale evaluated at 4 time-points (baseline, Day 15, Day 45, and Day 90) and (ii) the proportion of patients maintained without diuretic reuse during follow-up. We enrolled 188 patients (25% females; 5913years old; left ventricular ejection fraction=328%) that were randomized to furosemide withdrawal (n=95) or maintenance (n=93). For the first co-primary endpoint, no significant difference in patients' assessment of dyspnoea was observed in the comparison of furosemide withdrawal with continuous administration [median AUC 1875 (interquartile range, IQR 383-3360) and 1541 (IQR 474-3124), respectively; P=0.94]. For the second co-primary endpoint, 70 patients (75.3%) in the withdrawal group and 77 patients (83.7%) in the maintenance group were free of furosemide reuse during follow-up (odds ratio for additional furosemide use with withdrawal 1.69, 95% confidence interval 0.82-3.49; P=0.16). Heart failure-related events (hospitalizations, emergency room visits, and deaths) were infrequent and similar between groups (P=1.0). Conclusions Diuretic withdrawal did not result in neither increased self-perception of dyspnoea nor increased need of furosemide reuse. Diuretic discontinuation may deserve consideration in stable outpatients with no signs of fluid retention receiving optimal medical therapy.
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