Journal
JOURNAL OF CARDIAC FAILURE
Volume 23, Issue 8, Pages 589-593Publisher
CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS
DOI: 10.1016/j.cardfail.2017.04.001
Keywords
Heart failure; loop diuretics; dose; prognosis
Categories
Funding
- FEDER through the Operational Programme Competitiveness and Internationalization
- Foundation for Science and Technology FCT (Portuguese Ministry of Science, Technology and Higher Education) under the project A pharmacoepidemiological approach to the study of prognosis in acute and chronic heart failure [FCOMP-01-0124-FEDER-011019, FCT PTDC/S-AU-ESA/107940/2008]
- Unidade de Investigacao em Epidemiologia-Instituto de Saude Publica da Universidade do Porto (EPIUnit) [POCI-01-0145-FEDER-006862, UID/DTP/04750/2013]
- Fundação para a Ciência e a Tecnologia [UID/DTP/04750/2013, PTDC/SAU-ESA/107940/2008] Funding Source: FCT
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Background: High diuretic doses in chronic heart failure (HF) are potentially deleterious. We assessed the effect of dynamic furosemide dose on all-cause mortality among HF ambulatory patients. Methods and Results: A cohort of 560 ambulatory patients from an outpatient clinic specialized in HF, with median age 70 years, 67% male, and 89% with moderate-severely reduced ejection fraction, was retrospectively followed for up to 5 years. Dynamic furosamide exposure was categorized as low (0-59 mg/d), medium (60-119 mg/d), high (120-159 mg/d), and very high (>= 160 mg/d). Extended Cox models were used to estimate the association between time-varying diuretic dose and mortality. A dose-dependent crude association between higher doses of furosemide and death (hazard ratio [HR] = 1.34, 95% confidence interval (CI): 1.06-2.16; HR = 2.09, 95% CI: 1.54-2.84, for high and very high dose, respectively) was totally explained by patients' characteristics and disease severity indicators (adjusted HR = 0.94, 95% CI: 0.63-1.38; HR = 1.10, 95% CI: 0.79-1.55, for high and very high dose, respectively). Conclusion: In this context, higher doses of diuretic did not impair survival, but rather indicated greater severity of the patient's condition.
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