Higher normalized furosemide dose was an independent predictor of all-cause mortality in clinically stable outpatients with chronic heart failure (P=0.017).
Cohort (n=400)
Does higher orally administered furosemide dose predict all-cause mortality in outpatients with chronic HF and LVEF ≤ 45%?
Higher normalized furosemide doses are associated with increased all-cause mortality in clinically stable outpatients with chronic systolic heart failure, suggesting potential harm of high doses in the absence of congestion.
p-value: p=0.017
In chronic heart failure (HF), high daily doses of furosemide have been associated with increased mortality. The authors sought to evaluate the relationships between orally administered furosemide doses, clinical status, left ventricular (LV) dysfunction, N-terminal proBNP (NT-proBNP), and outcome in 400 outpatients with chronic HF and LV ejection fraction (EF) ≤ 45%. Clinical status, NT-proBNP levels, and estimated glomerular filtration rate (eGFR) were evaluated. Median follow-up duration was 32 months. The median values of daily-dose furosemide and of furosemide dose normalized to body surface area were 25 mg (12.5-62.5 mg) and 15 mg/m(2) (13-34 mg/m(2)), respectively. A total of 32% of patients had decompensated HF according to Framingham score and criteria for congestion. In clinically stable patients, a multivariable Cox model, which included clinical and echocardiographic parameters plus NT-proBNP, hemoglobin, and eGFR, showed that normalized furosemide dose (P=.017), anemia (P=.060), age (P=.080), and New York Heart Association class (P=.080) were predictors of all cause-mortality. In patients with decompensated HF, LV end-systolic volume index (P=.018), NT-proBNP (P=.060), and reduced eGFR (P=.070) were independently related to the outcome. Normalized furosemide dose was a major determinant of prognosis in patients with chronic HF but without ongoing signs and symptoms, and this suggests a possible negative interaction of this drug in clinically stable patients.
Dini et al. (Mon,) conducted a cohort in chronic systolic heart failure (n=400). furosemide was evaluated on all cause-mortality (p=0.017). Higher normalized furosemide dose was an independent predictor of all-cause mortality in clinically stable outpatients with chronic heart failure (P=0.017).