January 1, 2012Circulation JournalOpen Access

Superiority of Long-Acting to Short-Acting Loop Diuretics in the Treatment of Congestive Heart Failure

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Why the study?

Does the long-acting loop diuretic azosemide reduce cardiovascular death or unplanned heart failure hospitalization compared to the short-acting loop diuretic furosemide in patients with chronic heart failure?

Population

320 adults with chronic heart failure, mean age 71, 39% female, in Japan. Key inclusion criteria: clinical…

Comparison

Azosemide 30-60 mg/day oral, replacing previous… vs Furosemide 20-40 mg/day oral, replacing previous…

Design

RCT, 1:1 ratio, open, blinded endpoint (PROBE) design

Follow-up

median 35.2 months

Authors

TMTohru MasuyamaHeart Failure & Transplant TTTakeshi TsujinoKobe Medical Center HOHideki OrigasaPreventive Cardiology

Discussion

Member takes

Implication

Supports preferring azosemide over furosemide in chronic HF; extends randomized evidence for long-acting loop diuretics.

Structured PICO

Population

320 adults with chronic heart failure (NYHA class II or III, median LVEF 51%), mean age 71, 39% female, in Japan. Key inclusion criteria: clinical diagnosis of HF within 6 months, current loop diuretic user, and no change in baseline therapy or symptoms of HF within 1 month.

Intervention

Azosemide 30-60 mg/day oral (titrated up to 120 mg/day if needed), replacing previous loop diuretic, added to standard heart failure therapy.

Comparator

Furosemide 20-40 mg/day oral (titrated up to 80 mg/day if needed), replacing previous loop diuretic, added to standard heart failure therapy.

Outcome

Composite of cardiovascular death and unplanned admission to hospital for congestive HF at median 35.2 months follow-up, assessed by an independent blinded endpoint committee.composite

In patients with chronic heart failure, the long-acting loop diuretic azosemide significantly reduced the risk of cardiovascular death or unplanned heart failure hospitalization compared to the short-acting loop diuretic furosemide.

Limitations

Unplanned admission to hospital for congestive HF depended on the subjective judgment of the admitting doctor
Small number of patients and low incidence rate of the primary endpoint (6.2%/year) weakened statistical power
Most patients were assumed to be taking furosemide before randomization

Cite This Study

Masuyama et al. (2012) studied this question.

synapsesocial.com/papers/6a73a31638bf1d836e1af4e2 https://doi.org/10.1253/circj.cj-11-1500

Topics

Heart failure hospitalization Heart failure HFrEF treatment

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Superiority of Long-Acting to Short-Acting Loop Diuretics in the Treatment of Congestive Heart Failure

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Topics

Superiority of Long-Acting to Short-Acting Loop Diuretics in the Treatment of Congestive Heart Failure

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

Also Consider