Abstract 13897: Decreased Diuretic Efficiency Rather Than Total Diuretic Dose is Associated With Reduced Survival Following Heart Failure Hospitalization
Hypothesis: Baseline renal dysfunction is associated with low DE, which is associated with increased mortality.
Methods: Data from pts enrolled in any arm of the ROSE-AHF (N=355) and the stepped pharmacologic strategy arm of the CARRESS (N=87) trials were included. DE was defined as total 72h fluid output per total loop diuretic dose, expressed as 40 mg furosemide equivalents. DE was dichotomized into high and low DE based on median value for risk factor analysis as well as tertiles for analysis of outcomes.
Results: Median DE at 72h was 631 ml per 40 mg furosemide. At 72h, the high DE group had median fluid output of 9071 ml (IQR: 7075, 11720) with median furosemide dose of 320 mg (208, 480) compared to 8030 ml (6300, 9825) and 840 mg (600, 1240) for the low DE group. Weight change at 72h was 4.3 kg (IQR: 6.4, 1.9) vs. 2.9 kg (4.8, 1.4) in the high and low DE groups (p < 0.01).
After controlling for concomitant thiazide use and clinical trial treatment-arm assignment, cystatin C was the strongest baseline determinant of DE [OR 0.37 per 1mg/L increase; 95% CI: 0.24, 0.57 (P < 0.001)]. ACEI/ARB use and beta-blocker non-use at randomization were associated with increased DE, while diabetes and ischemic etiology were not. Low DE, fluid output, and weight loss at 72h were associated with increased risk of 60d death, while total diuretic dose was not (Table). Risk of death increased as DE decreased.
Conclusions: Low DE is related to intrinsic renal dysfunction and elevated cystatin C may help to identify pts requiring higher dose diuretics to achieved desired volume loss. High DE, greater fluid output and wt loss are all associated with improved survival, highlighting the clinical importance of decongestion.
Author Disclosures: M. Kiernan: None. S.R. Stevens: None. K. Anstrom: None. E.Y. Birati: None. K.B. Marguiles: Research Grant; Modest; Juventis Therapeutics, Celladon Corporation, Thoratec Corporation, Innolign Biomedial, LLC. Consultant/Advisory Board; Modest; Novo Nordisk, Astra-Zeneca. J. Butler: None. J. Grodin: None. D. Gupta: None. A. Meredith: None. S. LaRue: None. V.G. Davia-Roman: None. H. Tang: None. A. Hernandez: Consultant/Advisory Board; Modest; Bistol-Myers Squibb, GlaskoSmithKlein. L. de las Fuentes: None.
- © 2014 by American Heart Association, Inc.