What is the clinical evidence from this study?

Study design: Review. Population: Heart Failure (HFrEF and HFpEF). Intervention: Loop diuretics.

What question did this study set out to answer?

To evaluate recent evidence on the clinical efficacy, safety, and dosing outcomes of loop diuretics in patients with heart failure with reduced and preserved ejection fraction.

September 22, 2023CureusOpen Access

Loop diuretic choice shows no effect on HF outcomes, while higher doses link to renal decline.

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Why the study?

There is a paucity of quality evidence regarding the effect of loop diuretic use and dosing on clinical outcomes beyond symptomatic relief in patients with heart failure.

Does the choice and dosing of loop diuretics improve clinical outcomes and safety in patients with HFrEF and HFpEF?

Population

Patients with HF with reduced and preserved ejection fraction

Comparison

Loop diuretic use and dosing strategies

Design

Narrative review

Key result

The choice of specific loop diuretics did not significantly influence mortality or rehospitalization in patients with heart failure, whereas higher doses were consistently associated with declining renal function and hypotension.

Authors

RPRuth Pius GOGod-Dowell O Odukudu IOIsrael O. Olorundare

Discussion

Member takes

Overview

Higher loop diuretic doses may increase renal and hypotensive risks in HF; leaves open agent-specific effects for prospective trials.

Key Points

To evaluate recent evidence on the clinical efficacy, safety, and dosing outcomes of loop diuretics in patients with heart failure with reduced and preserved ejection fraction.
Searched EMBASE, PubMed, CINAHL, and Web of Science databases for cohort studies and randomized controlled trials published in English after 2018.
Excluded case reports, case series, cross-sectional studies, reviews, pediatric studies, and publications older than five years.
One registry-based study demonstrated a significant reduction in 30-day all-cause mortality in HFrEF patients receiving loop diuretics versus non-recipients (HR=0.73; 95% CI=0.57-0.94; p=0.016), but no statistically significant difference persisted at 60 days.
The specific choice among loop diuretic agents did not significantly alter mortality or heart failure rehospitalization rates in patients with either HFrEF or HFpEF.
Higher loop diuretic doses consistently correlated with adverse declines in renal function and hypotension across both heart failure phenotypes.

Structured PICO

Does the choice and dosing of loop diuretics improve clinical outcomes and safety in patients with HFrEF and HFpEF?

Population

Patients with heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF)

Intervention

Loop diuretics (furosemide, torsemide, bumetanide) and varying dosing strategies

Comparator

Different loop diuretics, different doses, or no loop diuretics

Outcome

Efficacy (all-cause mortality, HF rehospitalization) and safety (worsening renal function, hypotension)

The choice of loop diuretic does not significantly impact mortality or rehospitalization in heart failure, but higher doses increase the risk of worsening renal function and hypotension.

Limitations

Searched only four databases
Included only articles written in English and published after 2018
Included studies used different ejection fraction cutoffs for HFrEF and HFpEF, limiting accurate comparability of outcomes

Cite This Study

Pius et al. (2023) conducted a review in Heart Failure (HFrEF and HFpEF). Loop diuretics was evaluated. The choice of specific loop diuretics did not significantly influence mortality or rehospitalization in patients with heart failure, whereas higher doses were consistently associated with declining renal function and hypotension.

synapsesocial.com/papers/6a0f9ffde3460f6d4c1cd5a3 https://doi.org/10.7759/cureus.45794

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September 22, 2023CureusOpen Access

Loop diuretic choice shows no effect on HF outcomes, while higher doses link to renal decline.

View Full Paper

Ask AI

Bookmark

Why the study?

There is a paucity of quality evidence regarding the effect of loop diuretic use and dosing on clinical outcomes beyond symptomatic relief in patients with heart failure.

Does the choice and dosing of loop diuretics improve clinical outcomes and safety in patients with HFrEF and HFpEF?

Population

Patients with HF with reduced and preserved ejection fraction

Comparison

Loop diuretic use and dosing strategies

Design

Narrative review

Key result

Authors

RPRuth Pius GOGod-Dowell O Odukudu IOIsrael O. Olorundare

Discussion

Member takes

Overview

Higher loop diuretic doses may increase renal and hypotensive risks in HF; leaves open agent-specific effects for prospective trials.

Key Points

To evaluate recent evidence on the clinical efficacy, safety, and dosing outcomes of loop diuretics in patients with heart failure with reduced and preserved ejection fraction.
Searched EMBASE, PubMed, CINAHL, and Web of Science databases for cohort studies and randomized controlled trials published in English after 2018.
Excluded case reports, case series, cross-sectional studies, reviews, pediatric studies, and publications older than five years.
One registry-based study demonstrated a significant reduction in 30-day all-cause mortality in HFrEF patients receiving loop diuretics versus non-recipients (HR=0.73; 95% CI=0.57-0.94; p=0.016), but no statistically significant difference persisted at 60 days.
The specific choice among loop diuretic agents did not significantly alter mortality or heart failure rehospitalization rates in patients with either HFrEF or HFpEF.
Higher loop diuretic doses consistently correlated with adverse declines in renal function and hypotension across both heart failure phenotypes.

Structured PICO

Does the choice and dosing of loop diuretics improve clinical outcomes and safety in patients with HFrEF and HFpEF?

Population

Patients with heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF)

Intervention

Loop diuretics (furosemide, torsemide, bumetanide) and varying dosing strategies

Comparator

Different loop diuretics, different doses, or no loop diuretics

Outcome

Efficacy (all-cause mortality, HF rehospitalization) and safety (worsening renal function, hypotension)

The choice of loop diuretic does not significantly impact mortality or rehospitalization in heart failure, but higher doses increase the risk of worsening renal function and hypotension.

Limitations

Searched only four databases
Included only articles written in English and published after 2018
Included studies used different ejection fraction cutoffs for HFrEF and HFpEF, limiting accurate comparability of outcomes

Cite This Study

synapsesocial.com/papers/6a0f9ffde3460f6d4c1cd5a3 https://doi.org/10.7759/cureus.45794

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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