Continuous vs intermittent loop diuretics in acute Heart Failure (DIUR-AHF): a propensity matched analysis
G Ruocco, A Salzano, S Franceschi, F Pirrotta, A Pagliaro, P Severino, A D'amato, C D Vizza, G Crisci, M Guazzi, S Frea, G Pastorini, M Feola, F Fedele, A PalazzuoliAbstract
Background
Loop diuretic treatment remains the recommended treatment to solve congestion in acute heart failure(AHF) patients.However, a clear indication about the best infusion modality, the daily dose and the duration of the treatment, was not yet established.
Objectives
This is a propensity score analysis of the DIUR-AHF study which aims to investigate the effects of different diuretic administration modalities on congestion, renal function and post discharge outcome.
Methods
this is a multicenter, prospective, open-label, observational, case- control study comparing intermittent(IiV) versus continuous(CiV) furosemide infusion in AHF patients.Patients received IiV or CiV combined as a 1:1 ratio for a period of 72-120 hours.High dose(HD) was defined as a high loop diuretic dose >120 mg/day.Clinical outcome was evaluated in terms of death or heart failure re-hospitalization over 6 months follow-up period
Results
370 AHF patients were included in this analysis, 189 treated with CiV and 181 with IiV.At baseline CiV group showed increased median values of blood urea(BUN) (p=0.010) and creatinine (p=0.017).Dividing our sample according to loop diuretic dosage, HD dose group revealed similar congestion and weight loss compared to LD; however,HD group showed a reduced diuretic efficiency(DE) (-0.13[-0.22, -0.07] vs -0.32[-0.59, -0.20]kg/day;p<0.001), a reduced urinary spot sodium (65[48-78] vs 78[66-86] meq/l;p<0.001) and an increased rate of adverse event occurrence (55%vs 20%;p<0.001).Multivariable analysis confirmed the protective effect for N-terminal-pro B-type natriuretic peptide(NTproBNP)decrease (HR:0.38[0.25-0.56];p<0.001) and the increased risk for HD treatment(HR:2.53[1.64-3.90];p<0.001).
Conclusions
HD of loop diuretics infusion revealed an increased risk for adverse events together with reduced diuretic response.Our results extend previous findings revealing the association between HD diuretics’ dose and prognosis in patients with chronic HF.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.