SPC365

The need for diuretic therapy in spite of heart failure with reduced ejection fraction foundational therapy: a new marker of adverse prognosis?

Session: Posters (Sessão 3 - Écran 4) - Insuficiência Cardíaca 3 - Terapêutica Farmacológica
Speaker: Ana Margarida Martins

Congress: CPC 2022
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Margarida Martins; João Ribeiro Agostinho; Pedro Silvério António; Sara Couto Pereira; Joana Brito; Pedro Alves da Silva; Beatriz Valente Silva; Ana Beatriz Garcia; Catarina Simões de Oliveira; Rafael Santos; Joana Rigueira; Doroteia Silva; Nuno Lousada; Fausto j. Pinto; Dulce Brito

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong>The definition of Advanced Heart Failure (AHF) presented in the new heart failure (HF) ESC guidelines (GL) doesn&rsquo;t include the diuretic dose criterion. This criterion was only used in the AHA 2013 HF GL, where a dose equivalent to &gt; 160mg of furosemide was suggested as a marker of risk. However, this criterion was proposed prior to the establishment of HFrEF foundational therapy that includes 3 pharmacological classes with diuretic properties. </span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose</strong>: To evaluate whether diuretic doses may be used as a marker of AHF and to establish a diuretic dose cut-off to stratify HFrEF patients (pts).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong>: Consecutive pts with chronic HFrEF followed in a tertiary hospital multidisciplinary HF program were included. These pts were divided into 3 groups according to HF severity after therapy optimization: pts that fulfilled criteria for AHF (NYHA class: III-IV; &gt;1 HF decompensation requiring hospital visit/year; NTproBNP persistently &gt;3000pg/mL; LVEF &le;30%) &ndash; Group III; pts mainly in NYHA class II that fulfilled all the other AHF criteria &ndash; Group II; all other pts &ndash; Group I. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The median dose of diuretic used in Groups II and III pts (AHF pts) was calculated and its impact on HF related events (worsening heart failure, with or without hospitalizations, or death) on Group I (pts supposedly without AHF) was evaluated by Cox regression and Kaplan-Meyer analysis. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results: </strong>278 pts were included (mean age: 66&plusmn; 14years; female: 29.5%). The mean follow-up was 1.4&plusmn;1.14 years. The most frequent HF etiologies were ischemic heart disease (45.7%) and dilated cardiomyopathy (41.7%). </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Sixteen (5.8%) pts were included in Group III, 69 (24.8%) in Group II, and 193 (69.4%) in Group I - Table 1.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">During follow-up, 33 (11.9%) pts died and 61 (21.9%) had a HF event. As expected, HF events were more common in Groups II and III &ndash; Figure 1A. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The prescribed median diuretic dose (expressed as furosemide equivalent dose) was 0mg in Group I, 40mg in Group II and 50mg in Group III (p&lt;0.001).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In Group I, 52 (26.9%) pts required at least 40mg of furosemide and 18 (6.3%) pts at least 50 mg of furosemide. In those pts&nbsp;that needed more than 50 mg of furosemide 10 (62.5%) pts had an HF event during follow-up (HR 3.4; 95%CI 1.2-9.2; p=0.017) &ndash; Figure 1B.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion: </strong>In this cohort, diuretic doses were a useful marker of AHF. Persistent need of a dose of furosemide &ge;50mg may be used to stratify HFrEF pts with uncovered AHF and should prompt a thorough AHF investigation.</span></span></span></p>