Abstract 1655: Diuretic Doses and Mortality in 3632 Patients With Stable Chronic Heart Failure
Background: Diuretics are widely used in patients with congestive heart failure (HF). However, their effect on mortality has not been evaluated in large clinical trials.
Aim: To determine the dose-dependent relations between diuretic (D) doses and mortality in outpatients with chronic HF included in the nationwide Norwegian Heart Failure Registry.
Methods: The HF outpatient clinics are run by specially trained nurses in close cooperation with cardiologists. They constitute a network linked through a web-based HF database establ. in 1998. The daily dose of D was expressed in frusemide equivalents (bumetanid 1mg = frusemide 40 mg). An additional 10 mg was added if the patients also used a thiazide. The patients were divided into quartiles of equivalence of total daily dose of D. Data on mortality were obtained from the National Statistics Bureau.
Results: A total of 3632 patients, 70% males, mean age 71±12 yrs and mean ejection fraction of 33±12% were included. Betablockers were prescribed to 83%, angiontensin-converting enzyme inhibitors or angiotensin receptor blockers to 87% and spironolactone to 33% of the patients. The mean daily dose equivalence of D was 58± X mg. In multivariate analysis examining a host of variables, the dose equivalence of D showed the strongest correlation to mortality (hazard ratio 1.83; 95% confidence interval 1.48 to 2.27, p<0.001), i.e., a decrease in survival was observed with increasing diuretic dose (Fig⇓).
Conclusion: In patients with chronic HF, we observed a strong dose-dependent association between use of diuretics and mortality. Thus, the highest dosage of diuretics seems to be marker of HF patients at particularly high risk for reduced survival.