What question did this study set out to answer?

To determine whether increasing doses of oral furosemide correlate with reduced survival in outpatients with chronic heart failure and left ventricular systolic dysfunction.

June 13, 2013International Journal of Clinical Practice

Effects on survival of loop diuretic dosing in ambulatory patients with chronic heart failure using a propensity score analysis

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Why the study?

Are increasing doses of orally administered furosemide associated with increased all-cause mortality in outpatients with chronic heart failure and LV systolic dysfunction?

Key Points

To determine whether increasing doses of oral furosemide correlate with reduced survival in outpatients with chronic heart failure and left ventricular systolic dysfunction.
Assessed baseline transthoracic echo-Doppler and daily furosemide dosage in N=813 consecutive chronic heart failure outpatients with left ventricular ejection fraction ≤ 45%.
Followed patients for all-cause mortality over a mean follow-up period of 44 months.
Applied a multivariable logistic propensity score-stratified Cox proportional hazards model to adjust for confounding related to high-dose diuretic prescription.
All-cause mortality increased linearly across quartiles of furosemide dose after propensity score stratification (HR 1.38, 95% CI 1.14-1.68, p < 0.001).
A daily furosemide threshold of 50 mg best predicted 3-year mortality (ROC AUC 0.68, 95% CI 0.64-0.72).
The elevated risk of death with higher furosemide doses persisted regardless of left ventricular filling pattern, chronic kidney disease, or background therapy with ACE-inhibitors or beta-blockers.

Structured PICO

Are increasing doses of orally administered furosemide associated with increased all-cause mortality in outpatients with chronic heart failure and LV systolic dysfunction?

Population

813 consecutive outpatients with chronic heart failure (CHF) and left ventricular (LV) systolic dysfunction (LV ejection fraction ≤ 45%).

Intervention

Increasing doses of orally administered furosemide (assessed by total daily dose quartiles and a threshold of 50 mg).

Comparator

Lower doses of orally administered furosemide.

Outcome

All-cause mortalityhard clinical

Higher daily doses of furosemide (especially >50 mg) are associated with increased all-cause mortality in outpatients with HFrEF, independent of LV filling pattern, CKD, and background therapy.

Discussion

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Implication

Higher furosemide doses were associated with mortality in HFrEF outpatients; hypothesis-generating and should not change practice pending randomized trials.

Cite This Study

Dini et al. (2013) studied this question.

synapsesocial.com/papers/6a7ad225b2ad017e403232d3 https://doi.org/10.1111/ijcp.12144

Topics

Heart failure HFrEF treatment

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Implication

Higher furosemide doses were associated with mortality in HFrEF outpatients; hypothesis-generating and should not change practice pending randomized trials.

Effects on survival of loop diuretic dosing in ambulatory patients with chronic heart failure using a propensity score analysis

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Effects on survival of loop diuretic dosing in ambulatory patients with chronic heart failure using a propensity score analysis

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider