High-dose loop diuretics (>250 mg) were associated with increased waitlist mortality or urgent heart transplantation compared to low doses (≤40 mg) (adjusted HR 2.23; 95% CI 1.33-3.73; P=0.002).
Cohort (n=700)
Yes
Does high dose loop diuretic use predict waitlist death or urgent heart transplantation in ambulatory patients awaiting heart transplantation?
High-dose loop diuretic use (>250 mg furosemide equivalent) is a strong independent predictor of waitlist mortality and urgent heart transplantation in ambulatory patients with advanced heart failure.
Effect estimate: HR 2.23 (95% CI 1.33-3.73)
Absolute Event Rate: 25.6% vs 7.4%
p-value: p=0.002
AIMS: The prognostic value of 'high dose' loop diuretics in advanced heart failure outpatients is unclear. We aimed to assess the prognosis associated with loop diuretic dose in ambulatory patients awaiting heart transplantation (HT). METHODS AND RESULTS: All ambulatory patients (n = 700, median age 55 years and 70% men) registered on the French national HT waiting list between 1 January 2013 and 31 December 2019 were included. Patients were divided into 'low dose', 'intermediate dose', and 'high dose' loop diuretics corresponding to furosemide equivalent doses of ≤40, 40-250, and >250 mg, respectively. The primary outcome was a combined criterion of waitlist death and urgent HT. N-terminal pro-B-type natriuretic peptide, creatinine levels, pulmonary capillary wedge pressure, and pulmonary pressures gradually increased with higher diuretic dose. At 12 months, the risk of waitlist death/urgent HT was 7.4%, 19.2%, and 25.6% (P = 0.001) for 'low dose', 'intermediate dose', and 'high dose' patients, respectively. When adjusting for confounders, including natriuretic peptides, hepatic, and renal function, the 'high dose' group was associated with increased waitlist mortality or urgent HT adjusted hazard ratio (HR) 2.23, 1.33 to 3.73; P = 0.002 and a six-fold higher risk of waitlist death (adjusted HR 6.18, 2.16 to 17.72; P 0.05). CONCLUSIONS: A 'high dose' of loop diuretics is strongly associated with residual congestion and is a predictor of outcome in patients awaiting HT despite adjustment for classical cardiorenal risk factors. This routine variable may be helpful for risk stratification of pre-HT patients.
Baudry et al. (Wed,) conducted a cohort in Advanced heart failure awaiting heart transplantation (n=700). Loop diuretics vs. ≤40 mg furosemide equivalent (low dose) was evaluated on Combined criterion of waitlist death and urgent heart transplantation (HR 2.23, 95% CI 1.33-3.73, p=0.002). High-dose loop diuretics (>250 mg) were associated with increased waitlist mortality or urgent heart transplantation compared to low doses (≤40 mg) (adjusted HR 2.23; 95% CI 1.33-3.73; P=0.002).