An optimal dose of furosemide (20 mg/day) and spironolactone (40 mg/day) significantly improved LVEF and reduced re-hospitalization rates compared to furosemide alone or higher doses (P<0.05).
RCT (n=93)
Randomly divided
Does combined treatment with optimal dose furosemide and spironolactone improve echocardiographic parameters and clinical outcomes in elderly patients with diastolic heart failure?
A combination of 20 mg/day furosemide and 40 mg/day spironolactone optimizes echocardiographic improvements and minimizes electrolyte disorders and re-hospitalizations in elderly patients with mild diastolic heart failure.
p-value: p=<0.05
Diastolic heart failure (DHF) is characterized by symptoms including reduced ventricular relaxation and compliance, resulting in congestion of pulmonary and systemic circulation. The curative effects of regular cardiac agents are ineffective. Thus, new agents are required to treat chronic cardiac failure. The aim of the present study was to examine the clinical effects of the combined treatment by optimal dose of furosemide (20 mg/day) and spironolactone (40 mg/day) on elderly patients with diastolic heart failure (DHF) New York Heart Association (NYHA) 1-2 grade. A total of 93 patients diagnosed with DHF between February, 2013 and February, 2014 were enrolled in the present study. The patients were randomly divided into the furosemide group (20 mg/day, n=27), optimal dose group (20 mg/day furosemide+40 mg/day spirolactone, n=36), and large dose group (40 mg/day furosemide+100 mg/day spirolactone, n=30). Following treatment for one month, a comparison and analysis of the NYHA class, left ventricular ejection fraction (LVEF) and left ventricular end diastolic diameter (LVEDD), left ventricular wall segmental motion among the three groups were performed. The re-hospitalization rate of heart failure and incidence of electrolyte disorder among the three groups was compared and their differences analysed. Compared with pretreatment, the NYHA classifications of the three groups after treatment were reduced and differences were statistically significant (P0.05). Compared with pretreatment, LVEF of the optimal dose group increased, LVEDD decreased, and the average systolic myocardial peak velocity and early diastolic myocardial peak velocity of ventricular wall motion were reduced, with differences being statistically significant (P0.05). Improvement of the optimal dose group following treatment was more significant than the remaining two groups, and differences were statistically significant (P<0.05). The re-hospitalization rate of heart failure and incidence of electrolyte disorder in the optimal dose group following treatment were significantly less than the other two groups, and differences were statistically significant (P<0.05). In conclusion, the optimal dose (20 mg/day furosemide+40 mg/day spirolactone) significantly improved the clinical symptoms of elderly DHF patients (NYHA 1-2 grade) and ameliorated their long-term prognosis.
Chen et al. (Thu,) conducted a rct in Diastolic heart failure (n=93). Furosemide and spironolactone vs. Furosemide alone (20 mg/day) or large dose (40 mg/day furosemide + 100 mg/day spironolactone) was evaluated on NYHA class, LVEF, LVEDD, left ventricular wall segmental motion, re-hospitalization rate, and incidence of electrolyte disorder (p=<0.05). An optimal dose of furosemide (20 mg/day) and spironolactone (40 mg/day) significantly improved LVEF and reduced re-hospitalization rates compared to furosemide alone or higher doses (P<0.05).
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