Valente, M.A.E. et al. (2014) Diuretic response in acute heart failure: clinical characteristics and prognostic significance. European Heart Journal, 35(19), pp. 1284-1293. (doi: 10.1093/eurheartj/ehu065) (PMID:24585267)
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Abstract
Aim: Diminished diuretic response is common in patients with acute heart failure, although a clinically useful definition is lacking. Our aim was to investigate a practical, workable metric for diuretic response, examine associated patient characteristics and relationships with outcome. Methods and results: We examined diuretic response (defined as Δ weight kg/40 mg furosemide) in 1745 hospitalized acute heart failure patients from the PROTECT trial. Day 4 response was used to allow maximum differentiation in responsiveness and tailoring of diuretic doses to clinical response, following sensitivity analyses. We investigated predictors of diuretic response and relationships with outcome. The median diuretic response was −0.38 (−0.80 to −0.13) kg/40 mg furosemide. Poor diuretic response was independently associated with low systolic blood pressure, high blood urea nitrogen, diabetes, and atherosclerotic disease (all P < 0.05). Worse diuretic response independently predicted 180-day mortality (HR: 1.42; 95% CI: 1.11–1.81, P = 0.005), 60-day death or renal or cardiovascular rehospitalization (HR: 1.34; 95% CI: 1.14–1.59, P < 0.001) and 60-day HF rehospitalization (HR: 1.57; 95% CI: 1.24–2.01, P < 0.001) in multivariable models. The proposed metric—weight loss indexed to diuretic dose—better captures a dose–response relationship. Model diagnostics showed diuretic response provided essentially the same or slightly better prognostic information compared with its individual components (weight loss and diuretic dose) in this population, while providing a less biased, more easily interpreted signal. Conclusions: Worse diuretic response was associated with more advanced heart failure, renal impairment, diabetes, atherosclerotic disease and in-hospital worsening heart failure, and predicts mortality and heart failure rehospitalization in this post hoc, hypothesis-generating study.
| Item Type: | Articles |
|---|---|
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Cleland, Professor John and Damman, Dr Kevin |
| Authors: | Valente, M.A.E., Voors, A.A., Damman, K., Van Veldhuisen, D.J., Massie, B.M., O'Connor, C.M., Metra, M., Ponikowski, P., Teerlink, J.R., Cotter, G., Davison, B., Cleland, J.G.F., Givertz, M.M., Bloomfield, D.M., Fiuzat, M., Dittrich, H.C., and Hillege, H.L. |
| Subjects: | R Medicine > R Medicine (General) |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre |
| Journal Name: | European Heart Journal |
| Publisher: | Oxford University Press |
| ISSN: | 0195-668X |
| ISSN (Online): | 1522-9645 |
| Published Online: | 28 February 2014 |
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