scholarly journals Loop Diuretic Administration in Patients with Acute Heart Failure and Reduced Systolic Function: Effects of Different Intravenous Diuretic Doses and Diuretic Response Measurements

2019 ◽  
Vol 8 (11) ◽  
pp. 1854
Author(s):  
Gaetano Ruocco ◽  
Mauro Feola ◽  
Ranuccio Nuti ◽  
Lorenzo Luschi ◽  
Isabella Evangelista ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Poor Prognosis ◽  
Dose Group ◽  
Loop Diuretic ◽  
Systolic Function ◽  
Multivariable Analysis ◽  
High Dose ◽  
Diuretic Response ◽  
Infusion Period

Background: Despite the fact that loop diuretics are a landmark in acute heart failure (AHF) treatment, few trials exist that evaluate whether the duration and timing of their administration and drug amount affect outcome. In this study, we sought to evaluate different loop diuretic infusion doses in relation to outcome and to diuretic response (DR), which was serially measured during hospitalization. Methods: This is a post-hoc analysis of a DIUR-HF trial. We divided our sample on the basis of intravenous diuretic dose during hospitalization. Patients taking less than 125 mg of intravenous furosemide (median value) were included in the low dose group (LD), patients with a diuretic amount above this threshold were inserted in the high dose group (HD). The DR formula was defined as weight loss/40 mg daily of furosemide and it was measured during the first 24 h, 72 h, and over the whole infusion period. Outcome was considered as death due to cardiovascular causes or heart failure hospitalization. Results: One hundred and twenty-one AHF patients with reduced ejection fractions (EF) were evaluated. The cardiovascular (CV) death/heart failure (HF) re-hospitalization rate was significantly higher in the HD group compared to the LD group (75% vs. 22%; p < 0.001). Both low DR, measured during the entire infusion period (HR 3.25 (CI: 1.92–5.50); p < 0.001) and the intravenous diuretic HD (HR 5.43 [CI: 2.82–10.45]; p < 0.001) were related to outcome occurrence. Multivariable analysis showed that DR (HR 3.01 (1.36–6.65); p = 0.006), intravenous diuretic HD (HR 2.83 (1.24–6.42); p=0.01) and worsening renal function (WRF) (HR 2.21 (1.14–4.28); p = 0.01) were related to poor prognosis. Conclusions: HD intravenous loop diuretic administration is associated with poor prognosis and less DR. Low DR measured during the whole intravenous administration better predicts outcome compared to DR measured in the early phases. ClinicalTrials.gov Acronym and Identifier Number: DIUR-HF; NCT01441245; registered on 23 September 2011.

P3534Optimal dosing of initial bolus of intravenous furosemide in acute heart failure: insights from REALITY-AHF

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Matsue ◽  
T Okumura ◽  
K Kida ◽  
S Oishi ◽  
E Akiyama ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Stay ◽  
Acute Heart Failure ◽  
Dose Group ◽  
Standard Dose ◽  
Length Of Hospital Stay ◽  
Loop Diuretics ◽  
Recommended Dose ◽  
Diuretic Response ◽  
Initial Bolus

Abstract Background Although intravenous diuretics are a cornerstone in the treatment of patients with acute heart failure (AHF), optimal dosing of initial bolus of IV diuretics has not been well elucidated. Methods The initial IV bolus dose of furosemide and its association with outcomes were analyzed in 1290 AHF patients (median age, 81 years, 55% were male) derived from REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure). The patients were divided into 3 groups; lower dose (lower than recommended dose, n=371), standard dose (same as recommended dose, n=807), and higher dose (higher than recommended dose, n=112) groups according to the recommended initial IV bolus furosemide dose derived from the maintenance loop diuretics dose (for those without taking oral loop diuretics or taking ≤40mg/day oral furosemide-equivalent loop diuretics, 20mg IV bolus furosemide; those on >40mg/day oral furosemide-equivalent loop diuretics, IV bolus furosemide at the same dose as oral loop diuretic dose). Outcomes were length of hospital stay, diuretic response (urine output achieved within 48 hours of admission per 40 mg furosemide-equivalent diuretics dose), and 60-day all-cause mortality. Results Median amount of first IV bolus furosemide dose were 10, 20, and 40 mg for lower, standard, and higher dose groups, respectively. After adjustment for other covariates, length of hospital stay was significantly longer by 2.6 days (p=0.018) in the lower dose group compared to the standard dose group, and there was no difference between the standard and high dose groups (p=0.221). Diuretic response within 48 hours of admission was significantly better in the lower dose group (beta coefficient: 244 mL, p=0.025) and significantly worse in the higher dose group (beta coefficient: - 1098 mL, p<0.001) compared to the standard dose group after adjustment for covariates. During 60 days of admission, 91 deaths were observed, and 60-day mortality was significantly higher in the higher dose group (HR: 2.80, 95% CI: 1.49–5.26, p=0.001), but not in the lower dose group (HR: 1.18, 95% CI: 0.67–2.08, p=0.571) compared to the standard dose group after adjustment for other prognostic factors. Conclusion Treatment with the recommended initial bolus of IV furosemide is associated with a shorter hospital stay compared to lower dose regimen and better diuretic response and better 60-day survival compared to higher dose regimen in patients with AHF. Acknowledgement/Funding This study was funded by The Cardiovascular Research Fund, Tokyo, Japan.

scholarly journals The prevalence and clinical significance of anemia in patients hospitalized with acute heart failure

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 1006
Author(s):  
Attila Frigy ◽  
Zoltán Fogarasi ◽  
Ildikó Kocsis ◽  
Lehel Máthé ◽  
Előd Nagy
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Heart Failure ◽  
Clinical Picture ◽  
Loop Diuretic ◽  
High Dose ◽  
Chi Square ◽  
Frequent Finding ◽  
Chi Square Test ◽  
Prevalence Of Anemia

Abstract In a cohort of patients hospitalized with acute heart failure (AHF) the prevalence of anemia and the existence of a correlation between anemia and the severity of the clinical picture were assessed. Methods. 50 consecutive patients (34 men, 16 women, mean age 67.5 years) hospitalized with AHF were enrolled.  Statistical analysis was performed using a chi-square test, for studying univariate correlation between anemia and the presence of diverse parameters reflecting the severity and prognosis of AHF (α=0.05). Results. 21 patients (14 men, 7 women, mean age 69.6 years), representing 42%, had anemia (Hb<12 g/dl) at admission. Comparing patients with and without anemia there were no significant differences regarding age,  gender,  presence of atrial fibrillation (p=0.75), diabetes (p=1), ischemic heart disease (p=0.9), ejection fraction < 35% (p=1), hypotension at admission (p=0.34), tachycardia>100 b/min at admission (p=0.75), creatinine level >1.5mg% (p=0.12), and need of high dose of loop diuretic >80 mg/day (p=0.23). Conclusions. Anemia is a frequent finding in patients hospitalized with AHF. The presence of anemia was not correlated with other factors related to AHF severity and prognosis. This fact suggests its independent role in influencing the clinical picture and prognosis.

scholarly journals Effect of Aggressive Diuresis in Acute Heart Failure with Reduced and Preserved Ejection Fraction

2020 ◽  
Author(s):  
Chen Liu ◽  
Xin He ◽  
Bin Dong ◽  
Ruicong Xue ◽  
Jingjing Zhao ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Acute Heart Failure ◽  
Cystatin C ◽  
Dose Group ◽  
Low Dose ◽  
High Dose Group ◽  
High Dose ◽  
Preserved Ejection Fraction ◽  
Treatment Difference

Abstract Background: HFrEF and HFpEF had distinct hemodynamic characteristics in the setting of acute heart failure (AHF). The objective of our study is to evaluate the differential response to aggressive diuresis in Heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Methods: Patients in DOSE trial with left ventricular ejection fraction (LVEF) measurement were included (n=300), and classified into HFrEF (n=193) and HFpEF (n=107). Effect of high-dose versus low-dose furosemide strategy was compared separately in HFrEF and HFpEF. Results: High-dose strategy significantly increased change in creatinine and cystatin C at 72 hours in HFpEF (treatment difference: 0.16; 95% confidence interval [CI]: 0.02-0.30 mg/dl; P=0.03 for creatinine, and treatment difference: 0.26; 95% CI: 0.09-0.43 mg/dl; P=0.003 for cystatin C) but not in HFrEF (treatment difference: -0.05, 95% CI: -0.14-0.03 mg/dl; P=0.24 for creatinine, and treatment difference: -0.06, 95% CI: -0.15-0.02 mg/dl; P=0.15 for cystatin C) (P for interaction<0.01 for both). There were significantly more net fluid loss, weight loss, and congestion-free patients at 72 hours in high-dose group in HFrEF, but not in HFpEF. Compared with low-dose group, high-dose group had a significantly lower risk of composite clinical outcome of death, total hospitalizations and unscheduled visits due to heart failure (hazard ratio [HR]: 0.50, 95% CI: 0.27-0.93; P=0.03) in HFrEF, but a comparable risk (HR: 0.99, 95% CI: 0.48-0.23; P=0.98) in HFpEF.Conclusions: AHF on the basis of HFrEF and HFpEF responded differently to aggressive diuresis. Future trials should be designed separately for HFrEF and HFpEF.

Diuretic response and effects of diuretic omission in ambulatory heart failure patients on chronic low‐dose loop diuretic therapy

2021 ◽  
Author(s):  
Jeroen Dauw ◽  
Pieter Martens ◽  
Gregorio Tersalvi ◽  
Joren Schouteden ◽  
Sébastien Deferm ◽  
...  
Keyword(s):  
Heart Failure ◽  
Low Dose ◽  
Loop Diuretic ◽  
Diuretic Therapy ◽  
Heart Failure Patients ◽  
Diuretic Response

Tailoring diuretic therapy in acute heart failure: insight into early diuretic response predictors

2013 ◽  
Vol 102 (10) ◽  
pp. 745-753 ◽  
Author(s):  
João Pedro Ferreira ◽  
Mário Santos ◽  
Sofia Almeida ◽  
Irene Marques ◽  
Paulo Bettencourt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Diuretic Therapy ◽  
Response Predictors ◽  
Diuretic Response ◽  
Insight Into

Abstract 11983: Auraptene, a Coumaric Compounds Analogous, Improved the Worsening of Systolic Function by Activating Mitochondrial Function After Myocardial Infarction in Rats

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yoichi Sunagawa ◽  
Miho Suzuki ◽  
Masafumi Funamoto ◽  
Yasufumi Katanasaka ◽  
Hidetoshi Suzuki ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Lipid Metabolism ◽  
Mitochondrial Function ◽  
Low Dose ◽  
Systolic Function ◽  
Pharmacological Therapy ◽  
Vehicle Group ◽  
High Dose ◽  
Related Gene

Introduction: Heart failure is associated with pathological growth and mitochondrial dysfunction of constituent cardiomyocytes. To achieve effective oral pharmacological therapy for heart failure, we screened compounds isolated from natural products and found that auraptene derived from the peel of Citrus Hassaku may be applicable to pharmacological therapy for heart failure. Hypothesis: We assessed the hypothesis that auraptene could improve the deterioration of mitochondrial function and the development of heart failure in rats with myocardial infarction (MI). Methods and Results: In cultured cardiomyocytes, auraptene (2.5-10 μM) dose-dependently repressed phenylephrine-induced hypertrophic responses such as increase in cell size and ANF and ET-1 promoter activations. Auraptene also activated mitochondrial- and lipid metabolism-related gene transcriptions, such as PGC1α, PPARα/γ, mCPT1, UCP3, and PDK4. One week after operation, 22 rats with a moderate size of MI (Fractional shortening (FS) < 40%) were then randomly assigned to vehicle (n=8), auraptene low-dose (5 mg/kg/day, n=7), or high-dose (50 mg/kg/day, n=7). Oral daily treatments with these agents were continued for 6 weeks. There were no differences in left ventricle (LV) geometric and functional data among the 3 MI groups before treatment. After treatment, LVFS was significantly higher in the auraptene low-dose (21%, p < 0.0001) and high-dose (26%, p < 0.0001) groups than the vehicle group (16%). LV wall thickness in the remote non-infarct area was significantly thinner in the auraptene low-dose (1.4 mm, p < 0.01) and high-dose (1.2 mm, p < 0.0001) groups than the vehicle group (2.5 mm). Histological analysis demonstrated that auraptene treatment significantly suppressed MI-induced increases in myocardial cell diameter and perivascular fibrosis compared with vehicle treatment. Moreover, auraptene also prevented the activations of ANF and MCP-1 mRNA levels and up-regulated mitochondrial- and lipid metabolism-related gene transcriptions in LV. Conclusions: Auraptene treatment prevents the worsening of LV systolic function and represses hypertrophy after MI in adult rats. A natural compound, auraptene is expected as a novel useful agent for heart failure therapy in humans.

scholarly journals Clinical Predictors Influencing the Length of Stay in Emergency Department Patients Presenting with Acute Heart Failure

Medicina ◽  
2020 ◽  
Vol 56 (9) ◽  
pp. 434
Author(s):  
Pungkava Sricharoen ◽  
Phichayut Phinyo ◽  
Jayanton Patumanond ◽  
Dilok Piyayotai ◽  
Yuwares Sittichanbuncha ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Length Of Stay ◽  
Acute Heart Failure ◽  
Multivariable Analysis ◽  
Heart Association ◽  
Functional Class ◽  
Class Iii ◽  
Clinical Predictors ◽  
Nyha Functional Class

Background and objectives: Acute heart failure is a common problem encountered in the emergency department (ED). More than 80% of the patients with the condition subsequently require lengthy and repeated hospitalization. In a setting with limited in-patient capacity, the patient flow is often obstructed. Appropriate disposition decisions must be made by emergency physicians to deliver effective care and alleviate ED overcrowding. This study aimed to explore clinical predictors influencing the length of stay (LOS) in patients with acute heart failure who present to the ED. Materials and Methods: We conducted prognostic factor research with a retrospective cohort design. Medical records of patients with acute heart failure who presented to the ED of Ramathibodi Hospital from January to December 2015 were assessed for eligibility. Thirteen potential clinical predictors were selected as candidates for statistical modeling based on previous reports. Multivariable Poisson regression was used to estimate the difference in LOS between patients with and without potential predictors. Results: A total of 207 patients were included in the analysis. Most patients were male with a mean age of 74.2 ± 12.5 years. The median LOS was 54.6 h (Interquartile range 17.5, 149.3 h). From the multivariable analysis, four clinical characteristics were identified as independent predictors with an increase in LOS. These were patients with New York Heart Association (NYHA) functional class III/IV (+72.9 h, 95%Confidence interval (CI) 23.9, 121.8, p = 0.004), respiratory rate >24 per minute (+80.7 h, 95%CI 28.0, 133.3, p = 0.003), hemoglobin level <10 mg/dL (+60.4 h, 95%CI 8.6, 112.3, p = 0.022), and serum albumin <3.5 g/dL (+52.8 h, 95%CI 3.6, 102.0, p = 0.035). Conclusions: Poor NYHA functional class, tachypnea, anemia, and hypoalbuminemia are significant clinical predictors of patients with acute heart failure who required longer LOS.

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