Association between loop diuretic dose changes and outcomes in chronic heart failure: observations from the ESC-EORP Heart Failure Long-Term Registry.

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Fältnamn	Indikatorer	Metadata
000		05257naa a2200685 4500
001		oai:DiVA.org:uu-431018
003		SwePub
008		210113s2020 \| \|\|\|\|\|\|\|\|\|\|\|000 \|\|eng\|
009		oai:prod.swepub.kib.ki.se:232237110
009		oai:prod.swepub.kib.ki.se:143311775
024	7	a https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4310182 URI
024	7	a https://doi.org/10.1002/ejhf.17962 DOI
024	7	a http://kipublications.ki.se/Default.aspx?queryparsed=id:2322371102 URI
024	7	a http://kipublications.ki.se/Default.aspx?queryparsed=id:1433117752 URI
040		a (SwePub)uud (SwePub)kid (SwePub)ki
041		a engb eng
042		9 SwePub
072	7	a ref2 swepub-contenttype
072	7	a art2 swepub-publicationtype
100	1	a Kapelios, Chris J4 aut
245	1 0	a Association between loop diuretic dose changes and outcomes in chronic heart failure :b observations from the ESC-EORP Heart Failure Long-Term Registry.
264		c 2020-04
264	1	b Wiley,c 2020
338		a print2 rdacarrier
500		a Lars Wallentin ingår i gruppen "Heart Failure Long-Term Registry Investigators Group".
520		a AIMS: Guidelines recommend down-titration of loop diuretics (LD) once euvolaemia is achieved. In outpatients with heart failure (HF), we investigated LD dose changes in daily cardiology practice, agreement with guideline recommendations, predictors of successful LD down-titration and association between dose changes and outcomes.METHODS AND RESULTS: We included 8130 HF patients from the ESC-EORP Heart Failure Long-Term Registry. Among patients who had dose decreased, successful decrease was defined as the decrease not followed by death, HF hospitalization, New York Heart Association class deterioration, or subsequent increase in LD dose. Mean age was 66 ± 13 years, 71% men, 62% HF with reduced ejection fraction, 19% HF with mid-range ejection fraction, 19% HF with preserved ejection fraction. Median [interquartile range (IQR)] LD dose was 40 (25-80) mg. LD dose was increased in 16%, decreased in 8.3% and unchanged in 76%. Median (IQR) follow-up was 372 (363-419) days. Diuretic dose increase (vs. no change) was associated with HF death [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.12-2.08; P = 0.008] and nominally with cardiovascular death (HR 1.25, 95% CI 0.96-1.63; P = 0.103). Decrease of diuretic dose (vs. no change) was associated with nominally lower HF (HR 0.59, 95% CI 0.33-1.07; P = 0.083) and cardiovascular mortality (HR 0.62, 95% CI 0.38-1.00; P = 0.052). Among patients who had LD dose decreased, systolic blood pressure [odds ratio (OR) 1.11 per 10 mmHg increase, 95% CI 1.01-1.22; P = 0.032], and absence of (i) sleep apnoea (OR 0.24, 95% CI 0.09-0.69; P = 0.008), (ii) peripheral congestion (OR 0.48, 95% CI 0.29-0.80; P = 0.005), and (iii) moderate/severe mitral regurgitation (OR 0.57, 95% CI 0.37-0.87; P = 0.008) were independently associated with successful decrease.CONCLUSION: Diuretic dose was unchanged in 76% and decreased in 8.3% of outpatients with chronic HF. LD dose increase was associated with worse outcomes, while the LD dose decrease group showed a trend for better outcomes compared with the no-change group. Higher systolic blood pressure, and absence of (i) sleep apnoea, (ii) peripheral congestion, and (iii) moderate/severe mitral regurgitation were independently associated with successful dose decrease.
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Kardiologi0 (SwePub)302062 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Cardiac and Cardiovascular Systems0 (SwePub)302062 hsv//eng
653		a Chronic heart failure
653		a Drug titration
653		a Furosemide
653		a Loop diuretics
653		a Mortality
653		a Prognosis
700	1	a Laroche, Cécile4 aut
700	1	a Crespo-Leiro, Maria G4 aut
700	1	a Anker, Stefan D4 aut
700	1	a Coats, Andrew J S4 aut
700	1	a Díaz-Molina, Beatria4 aut
700	1	a Filippatos, Gerasimos4 aut
700	1	a Lainscak, Mitja4 aut
700	1	a Maggioni, Aldo P4 aut
700	1	a McDonagh, Theresa4 aut
700	1	a Mebazaa, Alexandre4 aut
700	1	a Metra, Marco4 aut
700	1	a Moura, Brenda4 aut
700	1	a Mullens, Wilfried4 aut
700	1	a Piepoli, Massimo F4 aut
700	1	a Rosano, Giuseppe M C4 aut
700	1	a Ruschitzka, Frank4 aut
700	1	a Seferovic, Petar M4 aut
700	1	a Lund, Lars Hu Karolinska Institutet4 aut
700	1	a Wallentin, Lars,d 1943-u Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),EORP Oversight Committee0 (Swepub:uu)larswall
710	2	a Karolinska Institutetb Uppsala kliniska forskningscentrum (UCR)4 org
773	0	t European Journal of Heart Failured : Wileyg 22:8, s. 1424-1437q 22:8<1424-1437x 1388-9842x 1879-0844
856	4	u https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ejhf.1796
856	4 8	u https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-431018
856	4 8	u https://doi.org/10.1002/ejhf.1796
856	4 8	u http://kipublications.ki.se/Default.aspx?queryparsed=id:232237110
856	4 8	u http://kipublications.ki.se/Default.aspx?queryparsed=id:143311775

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cardiac and Card ...

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