Key result
Lowest response-to-diuretic index linked to ~2.4-fold higher 6-month mortality, transplant, or HF readmission.
Why the study?
Diuretic response is an independent marker of outcomes in acute heart failure, prompting an analysis of two different formulas (diuretic response vs response to diuretic) for predicting 6-month clinical outcomes.
Does the response-to-diuretic (R-to-D) index predict 6-month clinical outcomes in patients discharged after acute decompensated heart failure?
Cohort (n=263)
No
Does the response-to-diuretic (R-to-D) index predict 6-month clinical outcomes in patients discharged after acute decompensated heart failure?
Answers are grounded in this paper and cite their sources.
Incorporating diuresis volume into weight-based diuretic response calculations improves short-term prognostic risk stratification for heart failure patients discharged after acute decompensation.
Background. The diuretic response has been shown to be a robust independent marker of cardiovascular outcomes in acute heart failure patients. The objectives of this clinical research are to analyze two different formulas (diuretic response (DR) or response to diuretic (R-to-D)) in predicting 6-month clinical outcomes. Methods: Consecutive patients discharged alive after an acute decompensated heart failure (ADHF) were enrolled. All patients underwent N-terminal-pro hormone BNP (NT-proBNP) and an echocardiogram together with DR and R-to-D calculation during diuretic administration. Death by any cause, cardiac transplantation and worsening heart failure (HF) requiring readmission to hospital were considered cardiovascular events. Results: 263 patients (62% male, age 78 years) were analyzed at 6-month follow-up. During the follow-up 58 (22.05%) events were scheduled. Patients who experienced CV-event had a worse renal function (p = 0.001), a higher NT-proBNP (p = 0.001), a lower left ventricular ejection fraction (p = 0.01), DR (p = 0.02) and R-to-D (p = 0.03). Spearman rho’s correlation coefficient showed a strong direct correlation between DR and R to D in all patients (r = 0.93; p < 0.001) and both in heart failure with reduced ejection fraction (HFrEF) (r = 0.94; p < 0.001) and HF preserved ejection fraction (HFpEF) (r = 0.91; p < 0.001). At multivariate analysis, a value of R-to-D <1.69 kg/40 mg, but only <0.67 kg/40 mg for DR were significantly related to poor 6-month outcome (p = 0.04 and p = 0.05, respectively). Receiver operating characteristic (ROC) curve analyses demonstrated that DR and R-to-D are equivalent in predicting prognosis (area under curve (AUC): 0.39 and 0.40, respectively). Only R-to-D was inversely related to in-hospital stay (r = −0.23; p = 0.01). Conclusion: Adding diuresis to DR seemed to provide a better risk assessment in alive HF patients discharged after an acute decompensation.
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Feola et al. (2020) conducted a cohort in Acute decompensated heart failure (ADHF) (n=263). Response to diuretic (R-to-D) index vs. Higher R-to-D index (higher quartiles) was evaluated on Composite of death by any cause, cardiac transplantation, and worsening heart failure requiring readmission at 6 months (HR 2.36, 95% CI 1.02-5.47, p=0.04). A response-to-diuretic (R-to-D) index in the lowest quartile was associated with an increased risk of 6-month mortality, transplantation, or heart failure readmission.
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