Key result
Loop diuretic use reaches ~81% in HFrEF, with higher doses linked to advanced symptoms.
Why the study?
To evaluate the use and dose of loop diuretics across the entire ejection fraction spectrum in a large, real-world cohort of chronic heart failure patients.
Observational (n=10,366)
Yes
Absolute Event Rate: 81.1% vs 73.8%
p-value: p=<0.001
In a real-world cohort, loop diuretic use is highly prevalent across all heart failure phenotypes, with higher doses strongly associated with advanced symptoms, diabetes, and renal impairment rather than ejection fraction.
High loop diuretic use across HF phenotypes warrants caution in observational dosing patterns; leaves open randomized trials on outcome impact.
INTRODUCTION: This study aimed to evaluate the use and dose of loop diuretics (LDs) across the entire ejection fraction (EF) spectrum in a large, 'real-world' cohort of chronic heart failure (HF) patients. METHODS: A total of 10 366 patients with chronic HF from 34 Dutch outpatient HF clinics were analysed regarding diuretic use and diuretic dose. Data regarding daily diuretic dose were stratified by furosemide dose equivalent (FDE)>80 mg or ≤80 mg. Multivariable logistic regression models were used to assess the association between diuretic dose and clinical features. RESULTS: In this cohort, 8512 (82.1%) patients used diuretics, of which 8179 (96.1%) used LDs. LD use was highest among HF with reduced EF (HFrEF) patients (81.1%) followed by HF with mild-reduced EF (76.1%) and HF with preserved ejection fraction EF (73.8%, p<0.001). Among all LDs users, the median FDE was 40 mg (IQR: 40-80). The results of the multivariable analysis showed that New York Heart Association classes III and IV and diabetes mellitus were one of the strongest determinants of an FDE >80 mg, across all HF categories. Renal impairment was associated with a higher FDE across the entire EF spectrum. CONCLUSION: In this large registry of real-world HF patients, LD use was highest among HFrEF patients. Advanced symptoms, diabetes mellitus and worse renal function were significantly associated with a higher diuretic dose regardless of left ventricular ejection fraction.
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Scholte et al. (2023) conducted an observational in chronic heart failure (n=10,366). Loop diuretics was evaluated on Loop diuretic use across ejection fraction categories (p=<0.001). Loop diuretic use was highest among HFrEF patients (81.1%) compared to HFmrEF (76.1%) and HFpEF (73.8%, p<0.001), with higher doses linked to advanced symptoms, diabetes, and renal impairment.
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