title: Prognostic Effect of the Dose of Loop Diuretic Over 5 Years in Chronic Heart Failure.
abstract: BACKGROUND
  High diuretic doses in chronic heart failure (HF) are potentially deleterious. We assessed the effect of dynamic furosemide dose on all-cause mortality among HF ambulatory patients.
  
  
  RESULTS
  A cohort of 560 ambulatory patients from an outpatient clinic specialized in HF, with median age 70 years, 67% male, and 89% with moderate-severely reduced ejection fraction, was retrospectively followed for up to 5 years. Dynamic furosamide exposure was categorized as low (0-59 mg/d), medium (60-119 mg/d), high (120-159 mg/d), and very high (≥160 mg/d). Extended Cox models were used to estimate the association between time-varying diuretic dose and mortality. A dose-dependent crude association between higher doses of furosemide and death (hazard ratio [HR] = 1.34, 95% confidence interval (CI): 1.06-2.16; HR = 2.09, 95% CI: 1.54-2.84, for high and very high dose, respectively) was totally explained by patients' characteristics and disease severity indicators (adjusted HR = 0.94, 95% CI: 0.63-1.38; HR = 1.10, 95% CI: 0.79-1.55, for high and very high dose, respectively).
  
  
  CONCLUSIONS
  In this context, higher doses of diuretic did not impair survival, but rather indicated greater severity of the patient's condition.
authors.affiliation: EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas n° 135, 4050-600 Porto, Portugal. Electronic address: olaszczynska@med.up.pt.
authors.forename: Olga
authors.initials: O
authors.lastname: Laszczyńska
authors.affiliation: EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas n° 135, 4050-600 Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
authors.forename: Milton
authors.initials: M
authors.lastname: Severo
authors.affiliation: Heart Failure Clinic, Department of Internal Medicine, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4202-451 Porto, Portugal; Cardiovascular Research Centre, University of Porto Medical School, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
authors.forename: Fernando
authors.initials: F
authors.lastname: Friões
authors.affiliation: Heart Failure Clinic, Department of Internal Medicine, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4202-451 Porto, Portugal; Cardiovascular Research Centre, University of Porto Medical School, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Lourenço
authors.affiliation: Heart Failure Clinic, Department of Internal Medicine, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4202-451 Porto, Portugal.
authors.forename: Sérgio
authors.initials: S
authors.lastname: Silva
authors.affiliation: Heart Failure Clinic, Department of Internal Medicine, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4202-451 Porto, Portugal; Cardiovascular Research Centre, University of Porto Medical School, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt
authors.affiliation: EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas n° 135, 4050-600 Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Lunet
authors.affiliation: EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas n° 135, 4050-600 Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Azevedo
mesh_terms: D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D004232:Diuretics / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D005665:Furosemide / Q000627:therapeutic use*; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011379:Prognosis; D012189:Retrospective Studies; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D004232:Diuretics; D049994:Sodium Potassium Chloride Symporter Inhibitors; D005665:Furosemide
keywords: Heart failure; dose; loop diuretics; prognosis