title: The effects of a sliding scale diuretic titration protocol in patients with heart failure.
abstract: 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.
authors.affiliation: Heart Failure Clinic, Carle Clinic, Department of Cardiology, Urbana, Ill. 61801, USA. MarilynPrasun@insightbb.com
authors.forename: Marilyn A
authors.initials: MA
authors.lastname: Prasun
authors.forename: Abraham G
authors.initials: AG
authors.lastname: Kocheril
authors.forename: Patricia H
authors.initials: PH
authors.lastname: Klass
authors.forename: Stephanie H
authors.initials: SH
authors.lastname: Dunlap
authors.forename: Mariann R
authors.initials: MR
authors.lastname: Piano
mesh_terms: 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
chemical_list: D004232:Diuretics; D020097:Natriuretic Peptide, Brain; D009638:Norepinephrine