Relation between dose of loop diuretics and outcomes in a heart failure population: Results of the ESCAPE Trial

Background: We examined the relation of maximal in-hospital diuretic dose to weight loss, changes in renal function, and mortality in hospitalised heart failure (HF) patients. Methods: In ESCAPE, 395 patients received diuretics in-hospital. Weight was measured at baseline, discharge, and every other day before discharge. Weight loss was defined as the difference between baseline and last in-hospital weight. Mortality was assessed using a log-logistic model with non-zero background. Results: Median weight loss: 2.8 kg (0.7, 6.1); mean: 3.7 kg (22% of values < 0). Weight loss and maximum in-hospital dose were correlated (p = 0.0007). Baseline weight, length of stay, and baseline brain natriuretic peptide were significant predictors of weight loss. After adjusting for these, dose was not a significant predictor of weight loss. A strong relation between dose and mortality was seen (p = 0.003), especially at > 300 mg/day. Dose remained a significant predictor of mortality after adjusting for baseline variables that significantly predicted mortality. Correlation between maximal dose and creatinine level change was not significant (r-.0.043; p=0.412) Conclusions: High diuretic doses during HF hospitalisation are associated with increased mortality and poor 6-month outcome. (c) 2007 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.