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Diuretic response in acute heart failure patients predicts 30-day hospitalization or emergency department visit
Session:
CO 22- Insuficiência cardíaca aguda
Speaker:
Inês Fialho
Congress:
CPC 2021
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Inês Fialho; Mariana Passos; Marco Beringuilho; João Baltazar Ferreira; Hilaryano Ferreira; Daniel Candeias Faria; Ana Oliveira Soares; David Cabrita Roque
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Background: </span></span></span></strong><span style="font-size:10pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Loop diuretics are the basis of congestion relief in acute heart failure (AHF). HF patients often present a reduced maximum diuretic response. The assessment of diuretic response remains a clinical challenge and its prognostic value has not been confirmed yet. </span></span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Objective:</span></span></span></strong> <span style="font-size:10pt"><span style="font-family:"Calibri Light",sans-serif">To evaluate the prognostic effect of diuretic response in AHF patients.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:"Calibri Light",sans-serif">Methods:</span></span></strong><span style="font-size:10pt"><span style="font-family:"Calibri Light",sans-serif"> We conducted an unicentric retrospective study of consecutive AHF patients admitted on the Day Hospital between January 2017 and October 2019 to receive </span></span><span style="font-size:10pt"><span style="font-family:"Calibri Light",sans-serif">furosemide by continuous infusion (</span></span><span style="font-size:10pt"><span style="font-family:"Calibri Light",sans-serif">FCI) for symptom control. Patients with no diuresis registry, in New York Heart Association (NYHA) class I-II, or with a NT pro-BNP level less than 900 ng/dL were excluded. For each patient demographic variables, NYHA class, left ventricle ejection fraction, ambulatory therapy, and clinical and laboratory data were recorded. FCI and diuresis registry were performed for 6 hours. Diuretic response was evaluated through urinary output adjusted to 40mg of furosemide and patient’s weight. </span></span><span style="font-size:10pt"><span style="font-family:"Calibri Light",sans-serif">Primary endpoint was a composite of 30-day hospitalization or emergency department (ED) visit for AHF.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Helvetica Neue""><span style="color:black"><strong><span style="font-size:10pt"><span style="font-family:"Calibri Light",sans-serif">Results</span></span></strong><span style="font-size:10pt"><span style="font-family:"Calibri Light",sans-serif">: A total of 1</span></span><span style="font-size:10pt"><span style="font-family:"Calibri Light",sans-serif">11</span></span><span style="font-size:10pt"><span style="font-family:"Calibri Light",sans-serif"> episodes were included. The median age was 73 (68-82) years, 63.1% (n=70) males. 80.2% of patients had HF with reduced ejection fraction (n=89), being 98.2% in NYHA class III (n=109) and 1.8% in class IV (n=2). Most were chronically medicated with diuretics (n=108, 97.3%). The median NT pro-BNP level was 5,213 (2,930-9,077) ng/dL. T</span></span><span style="font-size:10pt"><span style="font-family:"Calibri Light",sans-serif">he median furosemide dose administrated was 200 (200-200) mg, the median diuresis was 240 (157-350) mL per 40 mg of furosemide. The primary endpoint occurred in 46.8% of patients (n=52). Diuretic response was significantly lower in patients who presented the primary endpoint (2.4 mL vs 3.5 mL, 95% CI 7.5-114.3, <em>p</em>=0.001), while NT-pro BNP level was not significantly different (<em>p</em>=0.181). Diuretic response was an independent predictor of the primary endpoint (OR 0.684, 95% CI 0.535-0.875). The multivariate logistic regression model showed that diuretic response adjusted to age and serum creatinine performed even better as prognostic parameter (OR 0.594, 95% CI 0.415-0.850). This model </span></span><span style="font-size:10pt"><span style="font-family:"Calibri Light",sans-serif">yielded a good prognostic performance (AUC 0.789, CI 95% 0.686-0.910, <em>p</em><0.001).</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:"Calibri Light",sans-serif"><span style="color:black">Conclusions: </span></span></span></strong></span></span></span><span style="font-size:10pt"><span style="color:#000000"><span style="font-family:"Calibri Light",sans-serif">Diuretic response has prognostic value in our HF patients. </span></span></span><span style="font-size:10pt"><span style="color:#000000"><span style="font-family:"Calibri Light",sans-serif">Urinary output adjusted to 40 mg of furosemide and weight is an independent predictor of 30-day </span></span></span><span style="font-size:10pt"><span style="color:#000000"><span style="font-family:"Calibri Light",sans-serif">hospitalization or ED visit for AHF. </span></span></span></p>
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