Abstract 13490: Azosemide, a Long-acting Loop Diuretic, is Superior to Furosemide in Prevention of Cardiovascular Death in Heart Failure Patients Without Beta-blockade
Introduction: We have previously reported that a long-acting loop diuretic, azosemide, reduces a composite of cardiovascular death or unplanned admission to hospital for congestive heart failure in patients with chronic heart failure (CHF) as compared with short-acting one, furosemide, in Japanese Multicenter Evaluation of LOng- versus short-acting Diuretics In Congestive heart failure (J-MELODIC, Circ J. 2012; 76: 833-42). It might be due to the less activation of sympathetic nervous system in the long-acting diuretic group than in the short-acting diuretic group.
Hypothesis: We assessed the hypothesis that azosemide may be better than furosemide in preventing cardiovascular death particularly in patients without beta-blockade in this subanalysis.
Methods: In this multicenter, prospective, randomized, open, blinded endpoint trial, we compared effects of azosemide and furosemide in patients with CHF with New York Heart Association class II or III symptoms. Both heart failure with reduced EF and preserved EF were enrolled. 320 patients (160 patients in each group, mean age 71 years) were followed up for a minimum of 2 years. The Cox proportional hazards regression model was used to examine the effect of azosemide and furosemide on cardiovascular death in patients who did not receive beta-blockade.
Results: 140 patients did not receive beta-blockade at randomization (74 in the furosemide group, 66 in the azosemide group). These patients were characterized by older age (75±7 vs. 68±12) and larger LVEF (58.3±13.6 vs. 46.6±14.3) when compared to patients who received beta-blockade. In addition to gender, age (71 years or more), and LVEF (less than 50%), BUN (20 mg/dL or more), eGFR (60 ml/min/1.73m2 or less), azosemide or furosemide, and anemia (less than 13 g/dL in male, less than 12 g/dL in female) were selected as covariates in the Cox proportional hazards regression model based on univariate analysis. Cardiovascular death occurred in 3 patients in the azosemide group and 8 patients in the furosemide group (hazard ratio, 0.20, 95% confidence interval, 0.05 to 0.90: p = 0.036).
Conclusions: The use of long-acting diuretic rather than short-acting one is recommended in patients with CHF without beta-blockade.
- © 2013 by American Heart Association, Inc.