title: Association of furosemide dose with clinical status, left ventricular dysfunction, natriuretic peptides, and outcome in clinically stable patients with chronic systolic heart failure.
abstract: In chronic heart failure (HF), high daily doses of furosemide have been associated with increased mortality. The authors sought to evaluate the relationships between orally administered furosemide doses, clinical status, left ventricular (LV) dysfunction, N-terminal proBNP (NT-proBNP), and outcome in 400 outpatients with chronic HF and LV ejection fraction (EF) ≤ 45%. Clinical status, NT-proBNP levels, and estimated glomerular filtration rate (eGFR) were evaluated. Median follow-up duration was 32 months. The median values of daily-dose furosemide and of furosemide dose normalized to body surface area were 25 mg (12.5-62.5 mg) and 15 mg/m(2) (13-34 mg/m(2)), respectively. A total of 32% of patients had decompensated HF according to Framingham score and criteria for congestion. In clinically stable patients, a multivariable Cox model, which included clinical and echocardiographic parameters plus NT-proBNP, hemoglobin, and eGFR, showed that normalized furosemide dose (P=.017), anemia (P=.060), age (P=.080), and New York Heart Association class (P=.080) were predictors of all cause-mortality. In patients with decompensated HF, LV end-systolic volume index (P=.018), NT-proBNP (P=.060), and reduced eGFR (P=.070) were independently related to the outcome. Normalized furosemide dose was a major determinant of prognosis in patients with chronic HF but without ongoing signs and symptoms, and this suggests a possible negative interaction of this drug in clinically stable patients.
authors.affiliation: Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy. f.dini@ao-pisa.toscana.it
authors.forename: Frank L
authors.initials: FL
authors.lastname: Dini
authors.forename: Maya
authors.initials: M
authors.lastname: Guglin
authors.forename: Anca
authors.initials: A
authors.lastname: Simioniuc
authors.forename: Francesca
authors.initials: F
authors.lastname: Donati
authors.forename: Paolo
authors.initials: P
authors.lastname: Fontanive
authors.forename: Andrea
authors.initials: A
authors.lastname: Pieroni
authors.forename: Enrico
authors.initials: E
authors.lastname: Orsini
authors.forename: Paolo
authors.initials: P
authors.lastname: Caravelli
authors.forename: Mario
authors.initials: M
authors.lastname: Marzilli
mesh_terms: D000368:Aged; D016001:Confidence Intervals; D005260:Female; D005665:Furosemide / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D005919:Glomerular Filtration Rate; D054143:Heart Failure, Systolic / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D013223:Statistics as Topic; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000188:drug therapy*
chemical_list: D010446:Peptide Fragments; D049994:Sodium Potassium Chloride Symporter Inhibitors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D005665:Furosemide