The effects of a sliding scale diuretic titration protocol in patients with heart failure.
Patients with heart failure (HF) are often instructed to temporarily adjust their diuretic dose. This approach has become routine in some HF management programs; however, no study has specifically examined the effects of a patient-directed flexible diuretic protocol. For the purposes of this study, patients were randomized into a usual care (UC) group (n = 31) or a flexible diuretic titration (DT) group (n = 35). The DT group completed a 6-item diuretic titration protocol once a day, for 3 months. The 6-minute walk distance, plasma B-type natriuretic peptide (NT-BNP), plasma norepinephrine (NE), and quality of life (QOL) were measured at baseline and at 3 months. Hospitalizations, emergency department (ED) visits, and mortality rates were measured at 3 months. Compared to baseline, at 3 months, there was a significant increase in the DT group's 6-minute walk distance (646 +/- 60 ft vs 761 +/- 61 ft, P = .01) and total QOL score (53 +/- 5 vs 38 +/- 5, P = .001), whereas these parameters remained unchanged within the UC group. There were significantly less ED visits in the DT group compared with those in the UC group (3% vs 23%, P = .015). No differences were found between the groups in HF-related hospitalizations or mortality. Within both groups, no differences were found between baseline and 3-month NE or NT-BNP plasma values. Patients with heart failure who used a sliding scale diuretic titration protocol had significant improvements in their exercise tolerance and QOL, had fewer ED visits, and had no change in plasma NE or NT-BNP levels.
Prasun
Marilyn A
MA
Heart Failure Clinic, Carle Clinic, Department of Cardiology, Urbana, Ill. 61801, USA. MarilynPrasun@insightbb.com
Kocheril
Abraham G
AG
Klass
Patricia H
PH
Dunlap
Stephanie H
SH
Piano
Mariann R
MR
D002985:Clinical Protocols / Q000592:standards; D018450:Disease Progression; D004232:Diuretics / Q000008:administration & dosage* / Q000494:pharmacology; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000379:methods* / Q000592:standards; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005080:Exercise Test; D017079:Exercise Tolerance / Q000187:drug effects; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy* / Q000401:mortality / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood / Q000187:drug effects; D009638:Norepinephrine / Q000097:blood; D010343:Patient Admission / Q000706:statistics & numerical data; D011446:Prospective Studies; D011788:Quality of Life; D012646:Self Administration / Q000379:methods* / Q000592:standards; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000187:drug effects; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D004232:Diuretics; D020097:Natriuretic Peptide, Brain; D009638:Norepinephrine