title: Loop diuretic dose adjustments after a hospitalization for heart failure: insights from ASCEND-HF.
abstract: OBJECTIVE
  Loop diuretics are a cornerstone of heart failure (HF) treatment, but data regarding diuretic dose adjustments after a HF hospitalization and the association with subsequent outcomes are limited. This study was therefore conducted to determine these factors.
  
  
  RESULTS
  We analysed data from 6119 patients enrolled in ASCEND-HF, examining the association between loop diuretic use at the time of discharge, compared with admission, and the composite outcome of 30-day HF re-hospitalization or all-cause mortality. The majority of patients, 3921 (64%), were taking a loop diuretic on admission. At discharge, 3411 (56%) patients were prescribed higher doses compared with admission, including 1867 (31%) initiating daily outpatient diuretics; 1912 (31%) had no dose change and 795 (13%) were prescribed lower doses compared with admission. Initiation of an oral loop diuretic at discharge was independently associated with better 30-day outcomes compared with no dose change [adjusted odds ratio (OR) 0.51, 95% confidence interval (CI) 0.37-0.68]. However, for patients that were already established on a loop diuretic prior to admission, change in the dose at discharge was not associated with improved outcomes compared with no dose change (adjusted OR 0.92, 95% CI 0.79-1.07).
  
  
  CONCLUSIONS
  In a large multinational clinical trial, 56% of patients hospitalized with HF were either initiated on a daily loop diuretic at discharge or discharged on higher doses compared with admission. In patients established on diuretics prior to hospitalization, we found no association between changes to chronic doses at discharge and improved outcomes, whereas initiation of loop diuretic therapy was associated with better outcomes compared with no dose change.
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Adam D
authors.initials: AD
authors.lastname: DeVore
authors.forename: Vic
authors.initials: V
authors.lastname: Hasselblad
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
authors.forename: John J
authors.initials: JJ
authors.lastname: McMurray
authors.forename: Justin A
authors.initials: JA
authors.lastname: Ezekowitz
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
mesh_terms: D000368:Aged; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D045283:Natriuretic Agents / Q000008:administration & dosage*; D020097:Natriuretic Peptide, Brain / Q000008:administration & dosage*; D010343:Patient Admission; D010351:Patient Discharge; D012189:Retrospective Studies; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage*
chemical_list: D045283:Natriuretic Agents; D049994:Sodium Potassium Chloride Symporter Inhibitors; D020097:Natriuretic Peptide, Brain
keywords: Acute heart failure; Diuretics; Hospital readmission; Mortality