Key result
Doubling the dose of diuretics in outpatients with symptomatic heart failure significantly reduced weight (70 to 65 kg, P<0.001) and improved 6-minute walk distance (270 to 318 m, P<0.001).
Why the study?
Does doubling the dose of diuretics improve symptoms, weight, 6-minute walk distance, and echocardiographic measurements in outpatients with symptomatic heart failure with reduced ejection fraction?
Observational (n=51)
Does doubling the dose of diuretics improve symptoms, weight, 6-minute walk distance, and echocardiographic measurements in outpatients with symptomatic heart failure with reduced ejection fraction?
p-value: p=<0.001
Doubling the dose of diuretics in outpatients with symptomatic heart failure with reduced ejection fraction significantly improves symptoms, weight, and exercise capacity without altering left ventricular systolic or diastolic function.
May support short-term symptom relief in HFrEF outpatients; hypothesis-generating and requires randomized trials before practice change.
We investigated in 51 consecutive outpatients with symptomatic congestive heart failure caused by abnormal left ventricular (LV) ejection fraction treated with furosemide or torsemide (10% also with metolazone), beta blockers, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, 55% with spironolactone, and 18% with digoxin, the effects of doubling the dose of furosemide, torsemide, and metolazone on symptoms, weight, 6-minute walk distance, and echocardiographic measurements of LV systolic and diastolic function at 24 ± 6 days follow-up. At follow-up, the weight decreased from 70 ± 6 kg to 65 ± 6 kg (P < 0.001), the New York Heart Association functional class decreased from 2.9 ± 0.4 to 2.1 ± 0.2 (P < 0.001), the Minnesota With Heart Failure Questionnaire score decreased from 43 ± 7 to 28 ± 8 (P < 0.001), the 6-minute walk distance increased from 270 ± 46 m to 318 ± 44 m (P < 0.001), and there was no significant change in LV ejection fraction, LV end-diastolic dimension, LV end-systolic dimension, left atrial dimension, pulmonary artery systolic pressure, peak mitral early/ atrial ratio, mitral deceleration time, and velocity time interval. In conclusion, doubling the dose of diuretics in outpatients with symptomatic congestive heart failure caused a significant loss of weight and a significant improvement in symptoms and 6-minute walk distance but did not change LV systolic and diastolic function.
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Kumar et al. (2009) conducted an observational in Symptomatic congestive heart failure with reduced left ventricular ejection fraction (n=51). Doubling the dose of diuretics vs. Baseline was evaluated on Symptoms, weight, 6-minute walk distance, and echocardiographic measurements of LV systolic and diastolic function (p=<0.001). Doubling the dose of diuretics in outpatients with symptomatic heart failure significantly reduced weight (70 to 65 kg, P<0.001) and improved 6-minute walk distance (270 to 318 m, P<0.001).
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