Abstract 12346: Reduced Diuretic Response With Fluid Retention is a Poor Prognostic Factor in Patients With Acute Decompensated Heart Failure

Abstract

Introduction: Diuretic response (DR) has been proposed as a prognostic factor in heart failure patients. The presence of leg edema or jugular venous distention reflects fluid retention (FR) and patients are treated with diuretics under the guide of FR. However, the prognostic value of DR and FR has not been clarified. The aim of this study was to investigate the relation of DR and FR to the mortality in patients with acute decompensated heart failure. Methods: We enrolled 188 consecutive acute heart failure inpatients survived to discharge (mean age of 78 years, 101 females). DR was calculated by the formula; in-hospital Δbody weight kg / 80mg oral furosemide (or equivalent loop diuretic dose). FR on admission was simply evaluated by the presence of leg edema or jugular venous distention. All patients were divided into 4 groups based on the median of DR and FR; Group-A (DR≤-0.49 with FR, n=65), Group-B (DR≤-0.49 without FR, n=29), Group-C (DR>-0.49 with FR, n=47) and Group-D (DR>-0.49 without FR, n=47). We followed all patients up to one year after discharge. Cardiac events were defined as cardiac deaths and re-hospitalization for worsening heart failure. Results: The mean of LVEF was 44% and plasma BNP level was 960 pg/mL. The median length of stay was 18 days, the dose of furosemide was 570 mg, and the Δbody weight was -3.6 kg. The blood urea nitrogen level (p=0.001), creatinine level (p=0.004) and the prior exposure to loop diuretics (p<0.001) was significantly higher in the Group-C and D. The probability of cardiac events in the Group-C was significantly higher than that in any other groups (Figure). Adjusted multivariate analysis identified the Group-C as an independent predictor of cardiac events (HR: 2.32; 95% CI: 1.43-3.78; p=0.001). Conclusion: Reduced DR with FR is a poor prognostic factor in patients with acute decompensated heart failure.