Relation between dose of loop diuretics and outcomes in a heart failure population: results of the ESCAPE trial.
BACKGROUND
We examined the relation of maximal in-hospital diuretic dose to weight loss, changes in renal function, and mortality in hospitalised heart failure (HF) patients.


METHODS
In ESCAPE, 395 patients received diuretics in-hospital. Weight was measured at baseline, discharge, and every other day before discharge. Weight loss was defined as the difference between baseline and last in-hospital weight. Mortality was assessed using a log-logistic model with non-zero background.


RESULTS
Median weight loss: 2.8 kg (0.7, 6.1); mean: 3.7 kg (22% of values <0). Weight loss and maximum in-hospital dose were correlated (p=0.0007). Baseline weight, length of stay, and baseline brain natriuretic peptide were significant predictors of weight loss. After adjusting for these, dose was not a significant predictor of weight loss. A strong relation between dose and mortality was seen (p=0.003), especially at >300 mg/day. Dose remained a significant predictor of mortality after adjusting for baseline variables that significantly predicted mortality. Correlation between maximal dose and creatinine level change was not significant (r=0.043; p=0.412)


CONCLUSIONS
High diuretic doses during HF hospitalisation are associated with increased mortality and poor 6-month outcome.
Hasselblad
Vic
V
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27705, USA. victor.hasselblad@duke.edu
Gattis Stough
Wendy
W
Shah
Monica R
MR
Lokhnygina
Yuliya
Y
O'Connor
Christopher M
CM
Califf
Robert M
RM
Adams
Kirkwood F
KF
D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019992:Databases as Topic; D005260:Female; D005665:Furosemide / Q000009:adverse effects; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D007668:Kidney / Q000187:drug effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D015431:Weight Loss
D002316:Cardiotonic Agents; D049994:Sodium Potassium Chloride Symporter Inhibitors; D020097:Natriuretic Peptide, Brain; D005665:Furosemide
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