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Loop diuretic dose adjustments after a hospitalization for heart failure: insights from ASCEND-HF.

Publication ,  Conference
DeVore, AD; Hasselblad, V; Mentz, RJ; O'Connor, CM; Armstrong, PW; McMurray, JJ; Ezekowitz, JA; Tang, WHW; Starling, RC; Voors, AA; Califf, RM ...
Published in: Eur J Heart Fail
March 2015

AIMS: Loop diuretics are a cornerstone of heart failure (HF) treatment, but data regarding diuretic dose adjustments after a HF hospitalization and the association with subsequent outcomes are limited. This study was therefore conducted to determine these factors. METHODS AND RESULTS: We analysed data from 6119 patients enrolled in ASCEND-HF, examining the association between loop diuretic use at the time of discharge, compared with admission, and the composite outcome of 30-day HF re-hospitalization or all-cause mortality. The majority of patients, 3921 (64%), were taking a loop diuretic on admission. At discharge, 3411 (56%) patients were prescribed higher doses compared with admission, including 1867 (31%) initiating daily outpatient diuretics; 1912 (31%) had no dose change and 795 (13%) were prescribed lower doses compared with admission. Initiation of an oral loop diuretic at discharge was independently associated with better 30-day outcomes compared with no dose change [adjusted odds ratio (OR) 0.51, 95% confidence interval (CI) 0.37-0.68]. However, for patients that were already established on a loop diuretic prior to admission, change in the dose at discharge was not associated with improved outcomes compared with no dose change (adjusted OR 0.92, 95% CI 0.79-1.07). CONCLUSIONS: In a large multinational clinical trial, 56% of patients hospitalized with HF were either initiated on a daily loop diuretic at discharge or discharged on higher doses compared with admission. In patients established on diuretics prior to hospitalization, we found no association between changes to chronic doses at discharge and improved outcomes, whereas initiation of loop diuretic therapy was associated with better outcomes compared with no dose change.

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Published In

Eur J Heart Fail

DOI

EISSN

1879-0844

Publication Date

March 2015

Volume

17

Issue

3

Start / End Page

340 / 346

Location

England

Related Subject Headings

  • Sodium Potassium Chloride Symporter Inhibitors
  • Retrospective Studies
  • Patient Discharge
  • Patient Admission
  • Natriuretic Peptide, Brain
  • Natriuretic Agents
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
 

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DeVore, A. D., Hasselblad, V., Mentz, R. J., O’Connor, C. M., Armstrong, P. W., McMurray, J. J., … Hernandez, A. F. (2015). Loop diuretic dose adjustments after a hospitalization for heart failure: insights from ASCEND-HF. In Eur J Heart Fail (Vol. 17, pp. 340–346). England. https://doi.org/10.1002/ejhf.235
DeVore, Adam D., Vic Hasselblad, Robert J. Mentz, Christopher M. O’Connor, Paul W. Armstrong, John J. McMurray, Justin A. Ezekowitz, et al. “Loop diuretic dose adjustments after a hospitalization for heart failure: insights from ASCEND-HF.” In Eur J Heart Fail, 17:340–46, 2015. https://doi.org/10.1002/ejhf.235.
DeVore AD, Hasselblad V, Mentz RJ, O’Connor CM, Armstrong PW, McMurray JJ, et al. Loop diuretic dose adjustments after a hospitalization for heart failure: insights from ASCEND-HF. In: Eur J Heart Fail. 2015. p. 340–6.
DeVore, Adam D., et al. “Loop diuretic dose adjustments after a hospitalization for heart failure: insights from ASCEND-HF.Eur J Heart Fail, vol. 17, no. 3, 2015, pp. 340–46. Pubmed, doi:10.1002/ejhf.235.
DeVore AD, Hasselblad V, Mentz RJ, O’Connor CM, Armstrong PW, McMurray JJ, Ezekowitz JA, Tang WHW, Starling RC, Voors AA, Califf RM, Hernandez AF. Loop diuretic dose adjustments after a hospitalization for heart failure: insights from ASCEND-HF. Eur J Heart Fail. 2015. p. 340–346.
Journal cover image

Published In

Eur J Heart Fail

DOI

EISSN

1879-0844

Publication Date

March 2015

Volume

17

Issue

3

Start / End Page

340 / 346

Location

England

Related Subject Headings

  • Sodium Potassium Chloride Symporter Inhibitors
  • Retrospective Studies
  • Patient Discharge
  • Patient Admission
  • Natriuretic Peptide, Brain
  • Natriuretic Agents
  • Middle Aged
  • Male
  • Humans
  • Hospitalization