© 2007 European Society of Cardiology
Relation between dose of loop diuretics and outcomes in a heart failure population: Results of the ESCAPE Trial
a Duke Clinical Research Institute, Duke University Medical Center Durham, NC, United States
b Columbia University Medical Center New York, NY, United States
c University of North Carolina School of Medicine, Department of Medicine, Division of Cardiology Chapel Hill, NC, United States
* Corresponding author. Duke Clinical Research Institute, Biostatistics and Bioinformatics P.O. Box 17969, Durham, NC 27705. Tel.: +1 919 668 8739; fax: +1 919 668 7058. E-mail address: victor.hasselblad{at}duke.edu (V. Hasselblad).
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Abstract |
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Background: We examined the relation of maximal in-hospital diuretic dose to weight loss, changes in renal function, and mortality in hospitalised heart failure (HF) patients.
Methods: In ESCAPE, 395 patients received diuretics in-hospital. Weight was measured at baseline, discharge, and every other day before discharge. Weight loss was defined as the difference between baseline and last in-hospital weight. Mortality was assessed using a log-logistic model with non-zero background.
Results: Median weight loss: 2.8kg (0.7, 6.1); mean: 3.7kg (22% of values <0). Weight loss and maximum in-hospital dose were correlated (p=0.0007). Baseline weight, length of stay, and baseline brain natriuretic peptide were significant predictors of weight loss. After adjusting for these, dose was not a significant predictor of weight loss. A strong relation between dose and mortality was seen (p=0.003), especially at >300mg/day. Dose remained a significant predictor of mortality after adjusting for baseline variables that significantly predicted mortality. Correlation between maximal dose and creatinine level change was not significant (r=0.043; p=0.412)
Conclusions: High diuretic doses during HF hospitalisation are associated with increased mortality and poor 6-month outcome.
Key Words: Diuretics • Heart failure • Outcomes
Received July 4, 2007; Accepted July 9, 2007
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