Heart failureRelation of Loop Diuretic Dose to Mortality in Advanced Heart Failure
Section snippets
Patient population
The study population consisted of 1,354 consecutive patients with advanced systolic HF referred to a single university medical center for HF management and/or transplant evaluation from 1985 to 2004. Patients with left ventricular ejection fractions >40%, those with HF due to valvular disease, and those aged <18 years were excluded from the analysis. All patients were followed in a comprehensive HF management program, as previously described.4 This study was approved by the University of
Baseline characteristics of the cohort
The cohort was 76% male and ranged in age from 18 to 84 years (mean 53 ± 13). New York Heart Association class III and IV HF constituted 39% and 47% of the population, respectively. The mean left ventricular ejection fraction was 24 ± 7% (Table 1). Causes of HF were ischemic (47%) and idiopathic (33%); the remaining causes included alcohol induced, hypertrophic, and postpartum cardiomyopathy.
Diuretic dose and patient characteristics
There were 465 patients (34%) in the first quartile, with dose equivalence of 0 to 40 mg; 365 patients
Discussion
This study suggests that in patients with advanced systolic HF, the use of higher doses of loop diuretics is associated with significantly increased all-cause mortality. We observed that the highest diuretic doses (>160 mg) were associated with a significant increase in 1- and 2-year all-cause mortality compared with the lowest loop diuretic doses (0 to 40 mg). The association was not limited to the mode of death; death from any cause, death and urgent transplantation, progressive HF death, and
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This research was supported by the Ahmanson Foundation, Los Angeles, California. Dr. Horwich was supported by Training Grant 401357JI30608 from the National Institutes of Health, Bethesda, Maryland.