Back to Search
Start Over
Loop diuretic dose adjustments after a hospitalization for heart failure: insights from ASCEND-HF.
- Source :
-
European journal of heart failure [Eur J Heart Fail] 2015 Mar; Vol. 17 (3), pp. 340-6. Date of Electronic Publication: 2015 Jan 23. - Publication Year :
- 2015
-
Abstract
- Aims: 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.<br />Methods and 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).<br />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.<br /> (© 2015 The Authors. European Journal of Heart Failure © 2015 European Society of Cardiology.)
- Subjects :
- Aged
Double-Blind Method
Female
Hospitalization
Humans
Male
Middle Aged
Patient Admission
Patient Discharge
Retrospective Studies
Heart Failure drug therapy
Natriuretic Agents administration & dosage
Natriuretic Peptide, Brain administration & dosage
Sodium Potassium Chloride Symporter Inhibitors administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1879-0844
- Volume :
- 17
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- European journal of heart failure
- Publication Type :
- Academic Journal
- Accession number :
- 25619549
- Full Text :
- https://doi.org/10.1002/ejhf.235