Diuretic dose is a strong prognostic factor in ambulatory patients awaiting heart transplantation
Abstract Aims The prognostic value of ‘high dose’ loop diuretics in advanced heart failure outpatients is unclear. We aimed to assess the prognosis associated with loop diuretic dose in ambulatory patients awaiting heart transplantation (HT). Methods and results All ambulatory patients (n = 700, med...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-10-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.14467 |
| _version_ | 1797661433994936320 |
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| author | Guillaume Baudry Guillaume Coutance Richard Dorent Fabrice Bauer Katrien Blanchart Aude Boignard Céline Chabanne Clément Delmas Nicolas D'Ostrevy Eric Epailly Vlad Gariboldi Philippe Gaudard Céline Goéminne Sandrine Grosjean Julien Guihaire Romain Guillemain Mathieu Mattei Karine Nubret Sabine Pattier Emmanuelle Vermes Laurent Sebbag Kevin Duarte Nicolas Girerd |
| author_facet | Guillaume Baudry Guillaume Coutance Richard Dorent Fabrice Bauer Katrien Blanchart Aude Boignard Céline Chabanne Clément Delmas Nicolas D'Ostrevy Eric Epailly Vlad Gariboldi Philippe Gaudard Céline Goéminne Sandrine Grosjean Julien Guihaire Romain Guillemain Mathieu Mattei Karine Nubret Sabine Pattier Emmanuelle Vermes Laurent Sebbag Kevin Duarte Nicolas Girerd |
| author_sort | Guillaume Baudry |
| collection | DOAJ |
| description | Abstract Aims The prognostic value of ‘high dose’ loop diuretics in advanced heart failure outpatients is unclear. We aimed to assess the prognosis associated with loop diuretic dose in ambulatory patients awaiting heart transplantation (HT). Methods and results All ambulatory patients (n = 700, median age 55 years and 70% men) registered on the French national HT waiting list between 1 January 2013 and 31 December 2019 were included. Patients were divided into ‘low dose’, ‘intermediate dose’, and ‘high dose’ loop diuretics corresponding to furosemide equivalent doses of ≤40, 40–250, and >250 mg, respectively. The primary outcome was a combined criterion of waitlist death and urgent HT. N‐terminal pro‐B‐type natriuretic peptide, creatinine levels, pulmonary capillary wedge pressure, and pulmonary pressures gradually increased with higher diuretic dose. At 12 months, the risk of waitlist death/urgent HT was 7.4%, 19.2%, and 25.6% (P = 0.001) for ‘low dose’, ‘intermediate dose’, and ‘high dose’ patients, respectively. When adjusting for confounders, including natriuretic peptides, hepatic, and renal function, the ‘high dose’ group was associated with increased waitlist mortality or urgent HT [adjusted hazard ratio (HR) 2.23, 1.33 to 3.73; P = 0.002] and a six‐fold higher risk of waitlist death (adjusted HR 6.18, 2.16 to 17.72; P < 0.001) when compared with the ‘low dose’ group. ‘Intermediate doses’ were not significantly associated with these two outcomes in adjusted models (P > 0.05). Conclusions A ‘high dose’ of loop diuretics is strongly associated with residual congestion and is a predictor of outcome in patients awaiting HT despite adjustment for classical cardiorenal risk factors. This routine variable may be helpful for risk stratification of pre‐HT patients. |
| first_indexed | 2024-03-11T18:45:24Z |
| format | Article |
| id | doaj.art-2198f22fdc4b4e97acf5e17e84017db2 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-03-11T18:45:24Z |
| publishDate | 2023-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-2198f22fdc4b4e97acf5e17e84017db22023-10-12T02:48:44ZengWileyESC Heart Failure2055-58222023-10-011052843285210.1002/ehf2.14467Diuretic dose is a strong prognostic factor in ambulatory patients awaiting heart transplantationGuillaume Baudry0Guillaume Coutance1Richard Dorent2Fabrice Bauer3Katrien Blanchart4Aude Boignard5Céline Chabanne6Clément Delmas7Nicolas D'Ostrevy8Eric Epailly9Vlad Gariboldi10Philippe Gaudard11Céline Goéminne12Sandrine Grosjean13Julien Guihaire14Romain Guillemain15Mathieu Mattei16Karine Nubret17Sabine Pattier18Emmanuelle Vermes19Laurent Sebbag20Kevin Duarte21Nicolas Girerd22Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM DCAC, CHRU de Nancy, F‐CRIN INI‐CRCT, Reicatra Vandoeuvre‐lès‐Nancy 54500 FranceDepartment of Cardiac and Thoracic Surgery Cardiology Institute, Pitié Salpêtrière Hospital, Assistance Publique‐Hôpitaux de Paris (AP‐HP). Sorbonne University Medical School Paris FranceDepartment of Cardiac Surgery CHU Bichat‐Claude Bernard, AP‐HP, Université Paris VII Paris FranceDepartment of Cardiology and Cardiovascular Surgery Hospital Charles Nicolle Rouen FranceDepartment of Cardiology and Cardiac Surgery University Hospital of Caen, University of Caen Caen FranceDepartment of Cardiology and Cardiovascular Surgery CHU Michallon Grenoble FranceDepartment of Thoracic and Cardiovascular Surgery CHU Pontchaillou, Inserm U1099 Rennes FranceDepartment of Cardiology Centre Hospitalier Universitaire de Toulouse Toulouse FranceDepartment of Cardiology and Cardiac Surgery CHU Clermont‐Ferrand Clermont‐Ferrand FranceDepartment of Cardiology and Cardiovascular Surgery Hôpitaux Universitaires de Strasbourg Strasbourg FranceDepartment of Cardiac Surgery La Timone Hospital Marseille FranceDepartment of Cardiac Surgery, Anesthesiology and Critical Care Medicine Arnaud de Villeneuve Hospital, CHRU Montpellier Montpellier FranceDepartment of Cardiac Surgery CHU Lille, Institut Coeur‐Poumons Lille FranceDepartment of Cardiology and Cardiac Surgery Dijon University Hospital Dijon FranceDepartment of Cardiothoracic Surgery Marie Lannelongue Hospital, University of Paris Sud, Inserm U999 (Pulmonary Hypertension: Pathophysiology and Novel Therapies [PAH]) Le Plessis Robinson FranceDepartment of Cardiology and Cardiac Surgery European Georges Pompidou Hospital Paris FranceDepartment of Cardiology and Cardiac Surgery CHU de Nancy, Hopital de Brabois Nancy FranceDepartment of Thoracic and Cardiovascular Surgery Hôpital Cardiologique du Haut‐Lévêque, Université Bordeaux II Bordeaux FranceDepartment of Cardiology and Heart Transplantation Unit CHU Nantes Nantes FranceDepartment of Cardiothoracic Surgery Tours University Hospital Tours FranceDepartment of Heart Failure and Transplantation Hôpital Cardiovasculaire Louis Pradel, Hospices Civils de Lyon Bron FranceUniversité de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM DCAC, CHRU de Nancy, F‐CRIN INI‐CRCT, Reicatra Vandoeuvre‐lès‐Nancy 54500 FranceUniversité de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM DCAC, CHRU de Nancy, F‐CRIN INI‐CRCT, Reicatra Vandoeuvre‐lès‐Nancy 54500 FranceAbstract Aims The prognostic value of ‘high dose’ loop diuretics in advanced heart failure outpatients is unclear. We aimed to assess the prognosis associated with loop diuretic dose in ambulatory patients awaiting heart transplantation (HT). Methods and results All ambulatory patients (n = 700, median age 55 years and 70% men) registered on the French national HT waiting list between 1 January 2013 and 31 December 2019 were included. Patients were divided into ‘low dose’, ‘intermediate dose’, and ‘high dose’ loop diuretics corresponding to furosemide equivalent doses of ≤40, 40–250, and >250 mg, respectively. The primary outcome was a combined criterion of waitlist death and urgent HT. N‐terminal pro‐B‐type natriuretic peptide, creatinine levels, pulmonary capillary wedge pressure, and pulmonary pressures gradually increased with higher diuretic dose. At 12 months, the risk of waitlist death/urgent HT was 7.4%, 19.2%, and 25.6% (P = 0.001) for ‘low dose’, ‘intermediate dose’, and ‘high dose’ patients, respectively. When adjusting for confounders, including natriuretic peptides, hepatic, and renal function, the ‘high dose’ group was associated with increased waitlist mortality or urgent HT [adjusted hazard ratio (HR) 2.23, 1.33 to 3.73; P = 0.002] and a six‐fold higher risk of waitlist death (adjusted HR 6.18, 2.16 to 17.72; P < 0.001) when compared with the ‘low dose’ group. ‘Intermediate doses’ were not significantly associated with these two outcomes in adjusted models (P > 0.05). Conclusions A ‘high dose’ of loop diuretics is strongly associated with residual congestion and is a predictor of outcome in patients awaiting HT despite adjustment for classical cardiorenal risk factors. This routine variable may be helpful for risk stratification of pre‐HT patients.https://doi.org/10.1002/ehf2.14467Advanced heart failureDiureticHeart transplantCongestionCardiorenal syndrome |
| spellingShingle | Guillaume Baudry Guillaume Coutance Richard Dorent Fabrice Bauer Katrien Blanchart Aude Boignard Céline Chabanne Clément Delmas Nicolas D'Ostrevy Eric Epailly Vlad Gariboldi Philippe Gaudard Céline Goéminne Sandrine Grosjean Julien Guihaire Romain Guillemain Mathieu Mattei Karine Nubret Sabine Pattier Emmanuelle Vermes Laurent Sebbag Kevin Duarte Nicolas Girerd Diuretic dose is a strong prognostic factor in ambulatory patients awaiting heart transplantation ESC Heart Failure Advanced heart failure Diuretic Heart transplant Congestion Cardiorenal syndrome |
| title | Diuretic dose is a strong prognostic factor in ambulatory patients awaiting heart transplantation |
| title_full | Diuretic dose is a strong prognostic factor in ambulatory patients awaiting heart transplantation |
| title_fullStr | Diuretic dose is a strong prognostic factor in ambulatory patients awaiting heart transplantation |
| title_full_unstemmed | Diuretic dose is a strong prognostic factor in ambulatory patients awaiting heart transplantation |
| title_short | Diuretic dose is a strong prognostic factor in ambulatory patients awaiting heart transplantation |
| title_sort | diuretic dose is a strong prognostic factor in ambulatory patients awaiting heart transplantation |
| topic | Advanced heart failure Diuretic Heart transplant Congestion Cardiorenal syndrome |
| url | https://doi.org/10.1002/ehf2.14467 |
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