title: Prognostic implications of diuretic dose in chronic heart failure.
abstract: BACKGROUND
  Prognostic implications of diuretics dose are not completely understood. We aim to study the association between diuretic doses and long-term prognosis in patients with chronic stable heart failure (HF).
  
  
  RESULTS
  We conducted a retrospective cohort study of 244 patients followed at an outpatient HF clinic. Admission criteria were clinical stability in the previous 3 months and optimized medical therapy. Demographic characteristics, clinical, and laboratory parameters were recorded. Patients were followed for 2 years and the outcome was defined as all-cause death or hospital admission due to HF worsening. Patients on ≤ 80 mg furosemide were compared with those on higher doses. Patients were grouped according to furosemide dose (≤ 80 mg and >80 mg/d) and according to volemia as assessed by the sodium retention score: <3 (euvolemia) versus ≥ 3 (hypervolemia). Patients on higher diuretic doses (n = 79) were older, more hypervolemic, and more symptomatic. Patients on >80 mg furosemide had a higher risk of death or hospital admission (hazard ratio [HR]: 2.07, 95% confidence interval [CI]: 1.37-3.1). For each 40-mg furosemide tablet, there was a 67% increase in risk of an adverse outcome within 2 years. The increase in risk was independent of other variables crudely associated with prognosis. Among euvolemic patients, those on ≤ 80 mg/d furosemide performed better than those on higher doses. Among hypervolemic patients, the diuretic dose had no prognostic implications.
  
  
  CONCLUSIONS
  Higher diuretic doses associated strongly and independently with adverse long-term outcome in chronic HF. Possibly, in euvolemic patients, efforts should be made to reduce diuretic dose.
authors.affiliation: Heart Failure Clinic, Serviço de Medicina Interna-Hospital S. João, Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Martins
authors.forename: Patrícia
authors.initials: P
authors.lastname: Lourenço
authors.forename: José Paulo
authors.initials: JP
authors.lastname: Araújo
authors.forename: Joana
authors.initials: J
authors.lastname: Mascarenhas
authors.forename: Ricardo
authors.initials: R
authors.lastname: Lopes
authors.forename: Ana
authors.initials: A
authors.lastname: Azevedo
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D004232:Diuretics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005665:Furosemide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010953:Plasma Volume / Q000187:drug effects; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D004232:Diuretics; D005665:Furosemide