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Table of Contents
Vol. 113, No. 1, 2009
Issue release date: March 2009
Cardiology 2009;113:12–19
(DOI:10.1159/000164149)

Impact of Intravenous Loop Diuretics on Outcomes of Patients Hospitalized with Acute Decompensated Heart Failure: Insights from the ADHERE Registry

Peacock W.F. · Costanzo M.R. · De Marco T. · Lopatin M. · Wynne J. · Mills R.M. · Emerman C.L.
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Abstract

The optimal use of diuretics in decompensated heart failure remains uncertain. We analyzed data from the ADHERE registry to look at the impact of diuretic dosing. 62,866 patients receiving <160 mg and 19,674 patients ≥160 mg of furosemide were analyzed. The patients receiving the lower doses had a lower risk for in-hospital mortality, ICU stay, prolonged hospitalization, or adverse renal effects. These findings suggest that future studies should evaluate strategies for minimizing exposure to high doses of diuretics.



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References

  1. Heart Failure Society of America: Evaluation and management of patients with acute decompensated heart failure: Section 12 of HFSA 2006 Comprehensive Heart Failure Practice Guideline. J Card Fail 2006;12:e86–e103.
  2. Domanski M, Norman J, Pitt B, et al: Diuretic use, progressive heart failure, and death in patients in the Studies Of Left Ventricular Dysfunction (SOLVD). J Am Coll Cardiol 2003;42:705–708.
  3. Domanski M, Tian X, Haigney M, Pitt B: Diuretic use, progressive heart failure, and death in patients in the DIG study. J Card Fail 2006;12:327–332.
  4. Butler J, Forman DE, Abraham WT, et al: Relationship between heart failure treatment and development of worsening renal function among hospitalized patients. Am Heart J 2004;147:331–338.
  5. Forman DE, Butler J, Wang Y, et al: Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. J Am Coll Cardiol 2004;43:61–67.
  6. Eshaghian S, Horwich TB, Fonarow GC: Relation of loop diuretic dose to mortality in advanced heart failure. Am J Cardiol 2006;97:1759–1764.
  7. Adams KF, Fonarow GC, Emerman CL, et al: Characteristics and outcomes of patients hospitalized for heart failure in the United States (2001–2003): rationale, design and preliminary observations from the Acute Decompensated Heart Failure National Registry (ADHERE®). Am Heart J 2005;149:209–216.
  8. Muller JE, Turi ZG, Stone PH, et al: Digoxin therapy and mortality after myocardial infarction: experience in the MILIS study. N Engl J Med 1986;314:265–271.
  9. Berk RA, Newton PJ: Does arrest really deter wife battery? An effort to replicate findings of the Minneapolis Spouse Abuse Experiment. Am Sociol Rev 1985;50:253–262.
  10. Frigoletto FD, Lieberman E, Lang JM, et al: A clinical trial of active management of labor. N Engl J Med 1995;333:745–750.
  11. Furnival G, Wilson R: Regression by leaps and bounds. Technometrics 1974;16:499–511.

    External Resources

  12. Abraham WT, Adams KF, Fonarow GC, et al: In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the Acute Decompensated Heart Failure Registry (ADHERE®). J Am Coll Cardiol 2005;46:57–64.
  13. Nieminen MS, Bohm M, Cowie MR, et al: Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology. Eur Heart J 2005;26:384–416.
  14. DiDomenico RJ, Park HY, Southworth MR, et al: Guidelines for acute decompensated heart failure treatment. Ann Pharmacother 2004;38:649–660.
  15. McCurley JM, Hanlon SU, Wei SK, et al: Furosemide and the progression of left ventricular dysfunction in experimental heart failure. J Am Coll Cardiol 2004;44:1301–1307.
  16. Francis GS, Siegel RM, Goldsmith SR, et al: Acute vasoconstrictor response to intravenous furosemide in patients with chronic congestive heart failure: activation of the neurohumoral axis. Ann Intern Med 1985;103:1–6.
  17. Francis GS, Benedict C, Johnstone DE, et al: Comparison of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure: a substudy of the Studies of Left Ventricular Dysfunction (SOLVD). Circulation 1990;82:1724–1729.
  18. Kubo SH, Clark M, Laragh JH, et al: Identification of normal neurohormonal activity in mild congestive heart failure and stimulating effect of upright posture and diuretics. Am J Cardiol 1987;60:1322–1328.
  19. Cotter G, Weissgarten J, Metzkor E, et al: Increased toxicity of high-dose furosemide versus low-dose dopamine in the treatment of refractory congestive heart failure. Clin Pharmacol Ther 1997;62:187–193.
  20. Gottlieb SS, Brater DC, Thomas I, et al: BG9719 (CVT-124), an A1 adenosine receptor antagonist protects against the decline in renal function observed with diuretics therapy. Circulation 2002;105:1348–1353.
  21. Smith GL, Vaccarino V, Kosiborod M, et al: Worsening renal function: what is a clinically meaningful change in creatinine during hospitalization with heart failure? J Card Fail 2003;9:13–25.
  22. Gottlieb SS, Abraham W, Butler J, et al: The prognostic importance of different definition of worsening renal function in congestive heart failure. J Card Fail 2002;8:136–141.
  23. Krumholz HM, Chen YT, Vaccarino V, et al: Correlates and impact on outcomes of worsening renal function in patients > or = 65 years of age with heart failure. Am J Cardiol 2000;85:1110–1113.
  24. Juurlink DN, Mamdani MM, Lee DS, et al: Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Engl J Med 2004;351:543–551.
  25. Weber KT: Furosemide in the long-term management of heart failure: the good, the bad, and the uncertain. J Am Coll Cardiol 2004;44:1308–1310.
  26. Ahokas RA, Warrington KJ, Gerling IC, et al: Aldosteronism and peripheral blood mononuclear cell activation: a neuroendocrine-immune interface. Circ Res 2003;93:e124–e135.
  27. Neuberg GW, Miller AB, O’Connor CM, et al: Diuretic resistance predicts mortality in patients with advanced heart failure. Am Heart J 2002;144:31–38.
  28. Mehta RL, Pascual MT, Soroko S, et al: Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA 2002;288:2547–2553.
  29. Krämer BK, Schweda F, Riegger GA: Diuretic treatment and diuretic resistance in heart failure. Am J Med 1999;106:90–96.
  30. De Bruyne LK: Mechanisms and management of diuretic resistance in congestive heart failure. Postgrad Med J 2003;79:268–271.
  31. Cotter G, Metzkor E, Kaluski E, et al: Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet 1998;351:389–393.
  32. Peacock WF, Fonarow GC, Emerman CL, et al: Impact of early initiation of intravenous therapy for acute decompensated heart failure on outcomes in ADHERE. Cardiology 2007;107:44–51.


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