SPC365

Diuretic dose in chronic heart failure – the lower the better?

Session: Posters - D. Heart Failure
Speaker: Sara Cristina da Silva Borges

Congress: CPC 2021
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.4 Chronic Heart Failure – Treatment
Session Type: Posters
FP Number: ---
Authors: Sara Borges; José João Monteiro; Pedro Carvalho; Catarina Ribeiro Carvalho; Marta Catarina Bernardo; Miguel Moz; Ana Baptista; Catarina Ferreira; j. Ilídio Moreira
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">BACKGROUND:&nbsp; Heart failure (HF) is a major source of morbidity and mortality and loop d<span style="background-color:white"><span style="color:black">iuretics are the most common therapy used to relieve fluid retention and shortness of breath. Guidelines support the use of diuretics at the lowest clinically effective dose but </span></span>evidence is scarce about their role in clinical outcomes;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">AIM: To assess the prognostic impact of diuretic dose in chronic heart failure outpatients; </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">METHODS: Retrospective study of (pts) admitted in </span><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">heart failure clinic of a cardiology center from February/2018 to December/2020, </span></span></span><span style="font-family:&quot;Calibri Light&quot;,sans-serif">with an initial left ventricular ejection fraction (LVEF) &lt;40%; <span style="background-color:white"><span style="color:black">The exposure was diuretic dose in mg/kg at admission and after optimal medical therapy (OMT). Primary outcomes were all-cause mortality</span></span> and a composite of death, HF hospitalizations or emergency department admission; </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">RESULTS: <span style="background-color:white"><span style="color:black">We included 261 patients (mean age 71 +/- 11 years; 69% males; ~40% ischemic etiology). OMT was reached in 69% (193 pts); Median diuretic dose at admission was 0.43 &plusmn;0.3mg/kg vs 0.23&plusmn; 0.3mg/Kg after OMT (p&lt;0.001)</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Pts with no diuretic were younger (68 vs 72, p=0.01), have lower NT-ProBNP levels (527 vs 1087 ng/mL, p&lt;0.001 and better Left ventricular ejection fraction(43% vs 36%, p&lt;0.001)</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">After a median follow-up of 17 months (IQR 13-23), 10 patients died (5%) and 32 (17%) had composite endpoint . </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Diuretic dose after OMT was associated with mortality (HR 3.5, 95% CI: 1.8-6.7, p&lt;0.001) and with composite endpoint (HR 4.8, 95% CI 3.3-7, p&lt;0.001). When divided into 0mg/Kg, 0-1mg/lh, and &gt;1 mg/kg categories, there was a stepwise increased risk when compared to 0 mg/kg, with HR 2.6, 95% CI 1,0-6,6 for 0-1 mg/kg and HR 5.1, 95% CI 1,8-14 for &gt;1mg/kg (Figure 1). </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">In the multivariate analysis, after adjusting for age, weight, LVEF and funtional class NYHA, diuretic dosis was an independente predictor for death (HR 2.4, 95% CI: 1,5 -3,8; p&lt;0.001) and composite endpoint ( HR 2.2, 95% CI: 1,6 -3,1; p&lt;0.001) in the follow up;</span></span></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">CONCLUSION</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Diuretic dosis in chronic HF pts is a predictor of adverse events and those who remain without diuretic have better prognosis. Further studies are warranted to determine if systematic reduction of diuretic doses in euvolaemic HF patients can lead to improved clinical outcomes.</span></span></span></span></span></p>