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Dose of furosemide before admission predicts diuretic efficiency and long-term prognosis in acute heart failure

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dc.contributor.author Blázquez-Bermejo, Zorba
dc.contributor.author Farré López, Núria
dc.contributor.author Caravaca Perez, Pedro
dc.contributor.author Llagostera Martín, Marc
dc.contributor.author Morán-Fernández, Laura
dc.contributor.author Fort, Aleix
dc.contributor.author De-Juan, Javier
dc.contributor.author García-Cosio, María Dolores
dc.contributor.author Ruiz-Bustillo, Sonia
dc.contributor.author Delgado, Juan F.
dc.date.accessioned 2022-07-25T06:26:56Z
dc.date.available 2022-07-25T06:26:56Z
dc.date.issued 2022
dc.identifier.citation Blázquez-Bermejo Z, Farré N, Caravaca Perez P, Llagostera M, Morán-Fernández L, Fort A, et al. Dose of furosemide before admission predicts diuretic efficiency and long-term prognosis in acute heart failure. ESC Heart Fail. 2022 Feb; 9(1): 656-66. DOI: 10.1002/ehf2.13696
dc.identifier.issn 2055-5822
dc.identifier.uri http://hdl.handle.net/10230/53796
dc.description.abstract Aims: The outpatient diuretic dose is a marker of diuretic resistance and prognosis in chronic heart failure (HF). Still, the impact of the preadmission dose on diuretic efficiency (DE) and prognosis in acute HF is not fully known. Methods and results: we conducted an observational and prospective study. All patients admitted for acute HF treated with intravenous diuretic and at least one criterion of congestion on admission were evaluated. Decongestion [physical examination, hemoconcentration, N-terminal pro-brain natriuretic peptide (NT-proBNP) change, and lung ultrasound], DE (weight loss and urine output per unit of 40 mg furosemide), and urinary sodium were monitored on the fifth day of admission. DE was dichotomized into high-low based on the median value. A multivariate Cox regression analysis was conducted to find predictors of HF readmission or mortality. A total of 105 patients were included between July 2017 and July 2019. Mean age was 74.5 ± 12.0 years, 64.8% were male, 33.3% had de novo HF, and mean left ventricular ejection fraction was 46 ± 17%. Median follow-up was 26 [15-35] months. Low DE based on weight loss was associated with a higher previous dose of furosemide (odds ratio [OR] 1.01 [1.00-1.02]), thiazide treatment before admission (OR 9.37 [2.19-40.14]), and lower diastolic blood pressure (OR 0.95 [0.91-0.98]) in the multivariate regression model. Only previous dose of furosemide (OR 1.01 [1.00-1.02]) and haemoglobin at admission (OR 0.76 [0.58-0.99]) were associated with low DE based on urine output in the multivariate analysis. The correlation between the previous dose of furosemide and DE based on weight loss was poor (r = -0.12; P = 0.209) and with DE based on urine output was weak to moderate (r = -0.33; P < 0.001). Low DE based on weight loss and urine output was associated with lesser decongestion measured by NT-proBNP (P = 0.011; P = 0.007), hemoconcentration (P = 0.006; P = 0.044), and lung ultrasound (P = 0.034; P = 0.029), but not by physical examination (P = 0.506; P = 0.560). Survival and event-free survival in acute decompensated HF (ADHF) were lower than in de novo HF; a preadmission dose of furosemide > 80 mg in ADHF identified patients with particularly poor prognosis (log-rank < 0.001). In ADHF, the preadmission dose of furosemide (hazard ratio [HR] 1.34 [1.08-1.67] per 40 mg) and NT-proBNP at admission (HR 1.03 [1.01-1.06] per 1000 pg/mL) were independently associated with mortality or HF readmission in the multivariate Cox regression analysis. Conclusions: the outpatient dose of furosemide before acute HF admission predicts DE and must be taken into account when deciding on the initial diuretic dose. In ADHF, the outpatient dose of furosemide can predict long-term prognosis better than DE during hospitalization.
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher Wiley
dc.rights Copyright © 2021 Blázquez-Bermejo Z, Farré N, Caravaca Perez P, Llagostera M, Morán-Fernández L, Fort A, et al. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. Articles from ESC Heart Failure are provided here courtesy of Wiley-Blackwell
dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/
dc.title Dose of furosemide before admission predicts diuretic efficiency and long-term prognosis in acute heart failure
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.1002/ehf2.13696
dc.subject.keyword Acute heart failure
dc.subject.keyword Diuretic resistance
dc.subject.keyword Prognosis
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.type.version info:eu-repo/semantics/publishedVersion

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