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20.11.2020 | Original Paper

Intensification of pharmacological decongestion but not the actual daily loop diuretic dose predicts worse chronic heart failure outcome: insights from TIME-CHF

verfasst von: Justas Simonavičius, Micha T. Maeder, Casper G. M. J. Eurlings, Arantxa Barandiarán Aizpurua, Jelena Čelutkienė, Jūratė Barysienė, Stefan Toggweiler, Beat A. Kaufmann, Hans-Peter Brunner-La Rocca

Erschienen in: Clinical Research in Cardiology | Ausgabe 8/2021

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Abstract

Background

Both loop diuretics (LDs) and congestion have been related to worse heart failure (HF) outcome. The relationship between the cause and effect is unknown. The aim of this study was to investigate the interaction between congestion, diuretic use and HF outcome.

Methods

Six hundred and twenty-two chronic HF patients from TIME-CHF were studied. Congestion was measured by means of a clinical congestion index (CCI). Loop diuretic dose was considered at baseline and month 6. Treatment intensification was defined as the increase in LD dose over 6 months or loop diuretic and thiazide or thiazide-like diuretic co-administration. The end-points were survival and HF hospitalisation-free survival.

Results

High-LD dose at baseline and month 6 (≥ 80 mg of furosemide per day) was not identified as an independent predictor of outcome. CCI at baseline remained independently associated with impaired survival [hazard ratio (HR) 1.34, (95% confidence interval) (95% CI) (1.20–1.50), p < 0.001] and HF hospitalisation-free survival [HR 1.09, 95% CI (1.02–1.17), p = 0.015]. CCI at month 6 was independently associated with HF hospitalisation-free survival [HR 1.24, 95% CI (1.11–1.38), p < 0.001]. Treatment intensification was independently associated with survival [HR 1.75, 95% CI (1.19–1.38), p = 0.004] and HF hospitalisation-free survival [HR 1.69, 95% CI (1.22–2.35), p = 0.002]. Patients undergoing treatment intensification resulting in decongestion had better outcome than patients with persistent (worsening) congestion despite LD dose up-titration (p < 0.001).

Conclusion

Intensification of pharmacological decongestion but not the actual LD dose was related to poor outcome in chronic HF. If treatment intensification translated into clinical decongestion, outcome was better than in case of persistent or worsening congestion.

Graphic abstract

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Titel: Intensification of pharmacological decongestion but not the actual daily loop diuretic dose predicts worse chronic heart failure outcome: insights from TIME-CHF
verfasst von: Justas Simonavičius
Micha T. Maeder
Casper G. M. J. Eurlings
Arantxa Barandiarán Aizpurua
Jelena Čelutkienė
Jūratė Barysienė
Stefan Toggweiler
Beat A. Kaufmann
Hans-Peter Brunner-La Rocca
Publikationsdatum: 20.11.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Research in Cardiology / Ausgabe 8/2021
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-020-01779-7

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Intensification of pharmacological decongestion but not the actual daily loop diuretic dose predicts worse chronic heart failure outcome: insights from TIME-CHF