Response to diuretic (R-to-D) <1.69 kg/40 mg and diuretic response (DR) <0.67 kg/40 mg predicted poor 6-month outcomes (p=0.04 and p=0.05), with R-to-D providing better risk assessment.
Cohort (n=263)
Does the response to diuretic (R-to-D) formula compared to the diuretic response (DR) formula better predict 6-month clinical outcomes in patients discharged after acute decompensated heart failure?
Both the response to diuretic (R-to-D) and diuretic response (DR) formulas are equivalent in predicting 6-month clinical outcomes in patients discharged after acute decompensated heart failure, though R-to-D may offer slight advantages in assessing in-hospital stay.
Effect estimate: AUC 0.40 for R-to-D, 0.39 for DR
p-value: p=0.04 for R-to-D, 0.05 for DR
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.
Feola et al. (Fri,) conducted a cohort in Acute decompensated heart failure (ADHF) (n=263). Diuretic resistance formulas (diuretic response [DR] and response to diuretic [R-to-D]) was evaluated on Death by any cause, cardiac transplantation and worsening heart failure requiring readmission to hospital (AUC 0.40 for R-to-D, 0.39 for DR, p=0.04 for R-to-D, 0.05 for DR). Response to diuretic (R-to-D) <1.69 kg/40 mg and diuretic response (DR) <0.67 kg/40 mg predicted poor 6-month outcomes (p=0.04 and p=0.05), with R-to-D providing better risk assessment.