Diuretic dose trajectories in dilated cardiomyopathy: prognostic implications

Vincenzo Nuzzi; Antonio Cannatà; Pierpaolo Pellicori; Paolo Manca; Davide Stolfo; Caterina Gregorio; Giulia Barbati; Daniel I. Bromage; Theresa McDonagh; John G.F. Cleland; Marco Merlo; Gianfranco Sinagra

doi:10.1007/s00392-022-02126-8

Diuretic dose trajectories in dilated cardiomyopathy: prognostic implications

Vincenzo Nuzzi, Antonio Cannatà, Pierpaolo Pellicori, Paolo Manca, Davide Stolfo, Caterina Gregorio, Giulia Barbati, Daniel I. Bromage, Theresa McDonagh, John G.F. Cleland, Marco Merlo^*, Gianfranco Sinagra

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

Abstract

Background: For patients with heart failure, prescription of loop diuretics (LD) and of higher doses are associated with an adverse prognosis. We investigated LD dose trajectories and their associations with outcomes in patients with dilated cardiomyopathy (DCM). Methods: Associations between outcomes and both furosemide-equivalent dose (FED) at enrolment and change in FED in the subsequent 24 months were evaluated. According to FED trajectory, patients were classified as (i) dose↑ (FED increase by ≥ 50% or newly initiated); (ii) dose↓ (FED decrease by ≥ 50%); (iii) stable dose (change in FED by < 50%); and (iv) never-users. The primary outcome was all-cause-death/heart transplantation/ventricular-assist-device/heart failure hospitalization. The secondary outcome was all-cause-death/heart transplantation/ventricular-assist-device. Results: Of 1,131 patients enrolled, 738 (65%) were prescribed LD at baseline. Baseline FED was independently associated with outcome (HR per 20 mg increase: 1.12 [95% CI 1.04–1.22], p = 0.003).Of the 908 with information on FED within 24 months from enrolment, 31% were never-users; 29% were dose↓; 26% were stable dose and 14% were dose↑. In adjusted models, compared to never-users, stable dose had a higher risk of the primary outcome (HR 2.42 [95% CI 1.19–4.93], p = 0.015), while dose↑ had the worst prognosis (HR 2.76 [95% CI 1.27–6.03], p = 0.011). Results were similar for the secondary outcome. Compared to patients who remained on LD, discontinuation of LD (143, 24%) was associated with an improved outcome (HR 0.43 [95% CI 0.28–0.65], p < 0.001). Conclusions: In patients with DCM, LD use and increasing FED are powerful markers of adverse outcomes. Patients who never receive LD have an excellent prognosis. Graphical abstract: [Figure not available: see fulltext.].

Original language	English
Pages (from-to)	419-430
Number of pages	12
Journal	Clinical Research in Cardiology
Volume	112
Issue number	3
DOIs	https://doi.org/10.1007/s00392-022-02126-8
Publication status	Published - 17 Nov 2022

Keywords

Dilated cardiomyopathy
Heart failure
Long-term trajectories
Loop diuretics
Prognostic associations

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10.1007/s00392-022-02126-8

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@article{86694e6c980141a3bb2aa84737f83ae1,

title = "Diuretic dose trajectories in dilated cardiomyopathy: prognostic implications",

abstract = "Background: For patients with heart failure, prescription of loop diuretics (LD) and of higher doses are associated with an adverse prognosis. We investigated LD dose trajectories and their associations with outcomes in patients with dilated cardiomyopathy (DCM). Methods: Associations between outcomes and both furosemide-equivalent dose (FED) at enrolment and change in FED in the subsequent 24 months were evaluated. According to FED trajectory, patients were classified as (i) dose↑ (FED increase by ≥ 50% or newly initiated); (ii) dose↓ (FED decrease by ≥ 50%); (iii) stable dose (change in FED by < 50%); and (iv) never-users. The primary outcome was all-cause-death/heart transplantation/ventricular-assist-device/heart failure hospitalization. The secondary outcome was all-cause-death/heart transplantation/ventricular-assist-device. Results: Of 1,131 patients enrolled, 738 (65%) were prescribed LD at baseline. Baseline FED was independently associated with outcome (HR per 20 mg increase: 1.12 [95% CI 1.04–1.22], p = 0.003).Of the 908 with information on FED within 24 months from enrolment, 31% were never-users; 29% were dose↓; 26% were stable dose and 14% were dose↑. In adjusted models, compared to never-users, stable dose had a higher risk of the primary outcome (HR 2.42 [95% CI 1.19–4.93], p = 0.015), while dose↑ had the worst prognosis (HR 2.76 [95% CI 1.27–6.03], p = 0.011). Results were similar for the secondary outcome. Compared to patients who remained on LD, discontinuation of LD (143, 24%) was associated with an improved outcome (HR 0.43 [95% CI 0.28–0.65], p < 0.001). Conclusions: In patients with DCM, LD use and increasing FED are powerful markers of adverse outcomes. Patients who never receive LD have an excellent prognosis. Graphical abstract: [Figure not available: see fulltext.].",

keywords = "Dilated cardiomyopathy, Heart failure, Long-term trajectories, Loop diuretics, Prognostic associations",

author = "Vincenzo Nuzzi and Antonio Cannat{\`a} and Pierpaolo Pellicori and Paolo Manca and Davide Stolfo and Caterina Gregorio and Giulia Barbati and Bromage, {Daniel I.} and Theresa McDonagh and Cleland, {John G.F.} and Marco Merlo and Gianfranco Sinagra",

note = "Funding Information: Open access funding provided by Universit{\`a} degli Studi di Trieste within the CRUI-CARE Agreement. No funding was received to assist with the preparation of this manuscript. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = nov,

day = "17",

doi = "10.1007/s00392-022-02126-8",

language = "English",

volume = "112",

pages = "419--430",

journal = "Clinical Research in Cardiology",

issn = "1861-0684",

publisher = "Springer",

number = "3",

}

TY - JOUR

T1 - Diuretic dose trajectories in dilated cardiomyopathy

T2 - prognostic implications

AU - Nuzzi, Vincenzo

AU - Cannatà, Antonio

AU - Pellicori, Pierpaolo

AU - Manca, Paolo

AU - Stolfo, Davide

AU - Gregorio, Caterina

AU - Barbati, Giulia

AU - Bromage, Daniel I.

AU - McDonagh, Theresa

AU - Cleland, John G.F.

AU - Merlo, Marco

AU - Sinagra, Gianfranco

N1 - Funding Information: Open access funding provided by Università degli Studi di Trieste within the CRUI-CARE Agreement. No funding was received to assist with the preparation of this manuscript. Publisher Copyright: © 2022, The Author(s).

PY - 2022/11/17

Y1 - 2022/11/17

N2 - Background: For patients with heart failure, prescription of loop diuretics (LD) and of higher doses are associated with an adverse prognosis. We investigated LD dose trajectories and their associations with outcomes in patients with dilated cardiomyopathy (DCM). Methods: Associations between outcomes and both furosemide-equivalent dose (FED) at enrolment and change in FED in the subsequent 24 months were evaluated. According to FED trajectory, patients were classified as (i) dose↑ (FED increase by ≥ 50% or newly initiated); (ii) dose↓ (FED decrease by ≥ 50%); (iii) stable dose (change in FED by < 50%); and (iv) never-users. The primary outcome was all-cause-death/heart transplantation/ventricular-assist-device/heart failure hospitalization. The secondary outcome was all-cause-death/heart transplantation/ventricular-assist-device. Results: Of 1,131 patients enrolled, 738 (65%) were prescribed LD at baseline. Baseline FED was independently associated with outcome (HR per 20 mg increase: 1.12 [95% CI 1.04–1.22], p = 0.003).Of the 908 with information on FED within 24 months from enrolment, 31% were never-users; 29% were dose↓; 26% were stable dose and 14% were dose↑. In adjusted models, compared to never-users, stable dose had a higher risk of the primary outcome (HR 2.42 [95% CI 1.19–4.93], p = 0.015), while dose↑ had the worst prognosis (HR 2.76 [95% CI 1.27–6.03], p = 0.011). Results were similar for the secondary outcome. Compared to patients who remained on LD, discontinuation of LD (143, 24%) was associated with an improved outcome (HR 0.43 [95% CI 0.28–0.65], p < 0.001). Conclusions: In patients with DCM, LD use and increasing FED are powerful markers of adverse outcomes. Patients who never receive LD have an excellent prognosis. Graphical abstract: [Figure not available: see fulltext.].

AB - Background: For patients with heart failure, prescription of loop diuretics (LD) and of higher doses are associated with an adverse prognosis. We investigated LD dose trajectories and their associations with outcomes in patients with dilated cardiomyopathy (DCM). Methods: Associations between outcomes and both furosemide-equivalent dose (FED) at enrolment and change in FED in the subsequent 24 months were evaluated. According to FED trajectory, patients were classified as (i) dose↑ (FED increase by ≥ 50% or newly initiated); (ii) dose↓ (FED decrease by ≥ 50%); (iii) stable dose (change in FED by < 50%); and (iv) never-users. The primary outcome was all-cause-death/heart transplantation/ventricular-assist-device/heart failure hospitalization. The secondary outcome was all-cause-death/heart transplantation/ventricular-assist-device. Results: Of 1,131 patients enrolled, 738 (65%) were prescribed LD at baseline. Baseline FED was independently associated with outcome (HR per 20 mg increase: 1.12 [95% CI 1.04–1.22], p = 0.003).Of the 908 with information on FED within 24 months from enrolment, 31% were never-users; 29% were dose↓; 26% were stable dose and 14% were dose↑. In adjusted models, compared to never-users, stable dose had a higher risk of the primary outcome (HR 2.42 [95% CI 1.19–4.93], p = 0.015), while dose↑ had the worst prognosis (HR 2.76 [95% CI 1.27–6.03], p = 0.011). Results were similar for the secondary outcome. Compared to patients who remained on LD, discontinuation of LD (143, 24%) was associated with an improved outcome (HR 0.43 [95% CI 0.28–0.65], p < 0.001). Conclusions: In patients with DCM, LD use and increasing FED are powerful markers of adverse outcomes. Patients who never receive LD have an excellent prognosis. Graphical abstract: [Figure not available: see fulltext.].

KW - Dilated cardiomyopathy

KW - Heart failure

KW - Long-term trajectories

KW - Loop diuretics

KW - Prognostic associations

UR - http://www.scopus.com/inward/record.url?scp=85141966558&partnerID=8YFLogxK

U2 - 10.1007/s00392-022-02126-8

DO - 10.1007/s00392-022-02126-8

M3 - Article

C2 - 36385396

AN - SCOPUS:85141966558

SN - 1861-0684

VL - 112

SP - 419

EP - 430

JO - Clinical Research in Cardiology

JF - Clinical Research in Cardiology

IS - 3

ER -

Diuretic dose trajectories in dilated cardiomyopathy: prognostic implications

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