Low-Dose Diuretic Favorable in Patients with Chronic Heart Failure

SAN FRANCISCO, CA—Reduction of furosemide dose in stable patients with chronic heart failure (HF) is feasible, with no deterioration in clinical status, a study presented at ACC.13, the American College of Cardiology's 62nd Annual Scientific Session, has found.

“Moreover, it seems to be associated with a more favorable prognosis,” reported Ioannis Terrovitis, MD, from the University of Athens, 3rd Department of Cardiology, Athens, Greece, and colleagues. They noted that although “high doses of diuretics have been associated with increased mortality in HF,” it has been unclear whether the administered dose “represents a marker of disease severity or if diuretics exert an overall deleterious effect.”

The study investigated the feasibility of reducing high furosemide doses in patients with clinically stable HF and the impact of the intervention on outcome.

Patients with stable chronic HF receiving furosemide >120mg daily were included in the study. Excluded were patients with HF-related hospitalization and/or change in NYHA class or furosemide dose in the past 3 months. Patients were randomized 1:1 to either maintenance of daily furosemide (n=20) or to reduction to one-third of the dose of furosemide (n=20).

The two treatment groups exhibited similar baseline characteristics. Mean follow-up was 479 days (range, 153-693 days).

In the dose maintenance arm, no significant changes in body weight and NYHA class between baseline and follow-up were observed; however, plasma hemoglobin significantly decreased (13.4 ± 1.54 to 12.9 ± 1.37gr/dL; P=0.036) and serum creatinine increased (1.24 ± 0.30 to 1.59 ± 0.66mg/dL; P=0.017).

In the dose reduction arm, although furosemide was reduced to one-third and this reduction was maintained during follow-up (from 75.6 ± 37.0 to 74.1 ± 40.9mg; P=0.84), body weight and NYHA class were not affected. No significant changes were observed in hematology and biochemistry values.

In the furosemide dose maintenance arm, 40% of patients died or were hospitalized for any cause versus 15% of patients in the dose reduction arm (P=0.072). The rate of survival free of death or HF hospitalization was 75% in the dose maintenance arm versus 100% in the dose reduction arm (P=0.014).