Low and high doses of diuretics and the risk of death in patients with HF

Increased risk of mortality with doses of loop diuretics more than 80 Furo mgEq / day

According to data presented by researchers at the ACC.17 Scientific Session, an increased risk of mortality was observed with doses of loop diuretics of more than 80 Furo mgEq / day in patients with heart failure.

Kirkwood F. Adams of the University of North Carolina, Chapel Hill, North Carolina, and co-authors of the study, decided to investigate the relationship between a dose-related increase in mortality associated with loop diuretics in this patient population. The UNITE-HF registry is a prospective observational HF study that has registered most patients since 2000-2002. To study the relationship between low and high doses of loop diuretics and mortality.

“The base daily doses of the loop diuretic were recalculated into milligram equivalents of furosemide (Furo mgEq),” Adams said. The authors also evaluated the relative risk of death in specific doses against the lack of use of loop diuretics and specific doses of the loop diuretic.

The patient sample included in the analysis (n = 1.262) had an average age of 58 years with a creatinine of 1.43 and a LVEF fraction of 31%. Circular diuretics were taken at baseline in the majority (75%) of patients at an average dose of 40 mgEq / day; The lower quartile took less than 20 mgEq / day, and the upper quartile took more than 80 mgEq / day.

The study reported 661 deaths during 6.6 years of follow-up. “Mortality did not increase at low doses,” said Adams. Mortality was significantly lower in the group Furo mgEq / day versus 40 Furo mgEq / day (hazard ratio [0.64, 95% CI: 0.44-0.92, p <0.016). Similarly, mortality was significantly lower in the Furo mgEq / day group compared to 80 Furo mgEq / day (HR 0.73, 95% CI: 0.57-0.93, P <0.012). Although mortality was higher in high doses, the relative risk did not change at doses greater than 120 Furo mgEq / day (for all P> 0.176).

The results of this retrospective observational analysis showed that the use of a loop diuretic was associated with a higher mortality at doses greater than 80 Furo mgEq / day in patients with heart failure, the authors concluded.