Furosemide Dose Progression after Sodium-Glucose Transporter 2 Inhibitors in Advanced Heart Failure

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Advanced Heart Failure (n=85). Intervention: SGLT2 inhibitors (dapagliflozin or empagliflozin) vs. Baseline. Primary outcome: Mean furosemide dose (mg) (p=0.003).

Isabelle Bolfe; R. Ribeiro; Caroline Prager; João Vitor Bolfe; Ana Karyn Ehrenfried de Freitas

doi:10.36660/abchf.20250032i

January 1, 2025ABC Heart Failure & CardiomyopathyOpen Access

Furosemide Dose Progression after Sodium-Glucose Transporter 2 Inhibitors in Advanced Heart Failure

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Key result

SGLT2i initiation is linked to a ~33% increase in mean furosemide dose in advanced HF.

P=0.003
n=85

Why the study?

To analyze the impact of introducing SGLT2i in patients with HF, focusing on a potential reduction in outpatient furosemide use over time alongside changes in renal function and congestion signs.

Does SGLT2i reduce outpatient furosemide use over time in patients with advanced heart failure?

Key Points

To evaluate whether initiating sodium-glucose cotransporter-2 (SGLT2) inhibitors reduces outpatient furosemide dosing and to assess concomitant changes in renal function and congestion in advanced heart failure.
Retrospective medical record review of 85 outpatients with advanced heart failure using furosemide who initiated SGLT2 inhibitors at a cardiology clinic over 1.5 years.
Outcomes included furosemide dose progression across four visits, changes in serum creatinine, and clinical signs of congestion (jugular venous distension, lower-limb edema, pulmonary crackles).
Mean furosemide dose increased from 59.66 ± 4.87 mg at SGLT2 inhibitor prescription to 70.97 ± 5.70 mg at the first visit, 67.14 ± 6.52 mg at the second visit, and 79.05 ± 7.28 mg at the third visit (p = 0.003 overall; paired p = 0.001 at first visit lost significance after Bonferroni adjustment).
Serum creatinine levels showed a statistically significant progressive increase across the four evaluation time points (p = 0.002; p = 0.023 from prescription to first visit, p = 0.007 from first to second visit).
Clinical signs of congestion improved over follow-up, with jugular venous distension decreasing from 32.9% to 24.7% and lower-limb edema declining from 35.3% to 22.4%.

Study Design

Type

Observational (n=85)

Multicenter

No

Structured PICO

Does SGLT2i reduce outpatient furosemide use over time in patients with advanced heart failure?

P

Population

85 patients with advanced heart failure

I

Intervention

Sodium-Glucose Transporter 2 Inhibitors (SGLT2i)

O

Outcome

Reduction in outpatient furosemide use over time, concomitant changes in renal function, and clinical signs of congestionsurrogate

Main Result

Absolute Event Rate: 79.05% vs 59.66%

p-value: p=0.003

Limitations

Retrospective design
Absence of a control group
Possibility of selection bias resulting from the exclusion of follow-up visits with intervals shorter than 30 days
Assessment of congestion was extracted from medical record entries
Lack of standardization of diuretic equivalents

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Implication

May reduce furosemide needs after SGLT2i in HF; hypothesis-generating, prospective trials needed before practice change.

Abstract

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Discussion

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Cite This Study

Bolfe et al. (2025) conducted an observational in Advanced Heart Failure (n=85). SGLT2 inhibitors (dapagliflozin or empagliflozin) vs. Baseline was evaluated on Mean furosemide dose (mg) (p=0.003). In patients with advanced heart failure, the introduction of SGLT2 inhibitors was associated with a significant increase in mean furosemide dose from to.

synapsesocial.com/papers/6a17db4d3fad632b0f9d80b6 https://doi.org/10.36660/abchf.20250032i

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Furosemide Dose Progression after Sodium-Glucose Transporter 2 Inhibitors in Advanced Heart Failure

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Furosemide Dose Progression after Sodium-Glucose Transporter 2 Inhibitors in Advanced Heart Failure

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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