Abstract 18604: The Prognostic Value of Diuretic Dose in Stable Chronic Heart Failure Patients

Abstract

Background: High daily diuretic dose (DDD) in chronic heart failure (HF) patients (pts) is related to cardiac and renal dysfunction but its relationship with outcomes in this population is still not completely understood. The aim of this study was to evaluate the prognostic implications of DDD in pts with chronic HF. Methods: Retrospective analysis of pts with HF and reduced Left Ventricular Ejection Fraction (LVEF<45%), followed at our outpatient HF clinic. Inclusion criteria were optimized therapy and clinical stability (neither events nor therapeutic changes) in the previous 3 months. Hypervolemic or euvolemic status was defined according to the sodium retention score (NaRS). We considered DDD as a continuous variable. Patients were followed prospectively for the occurrence of the composite endpoint cardiovascular (CV) death and hospitalizations for HF or CV causes after one- year follow-up. Results: A total of 528 pts (mean age 66.9 ± 13 years, 82% male) were enrolled. Overall, at one-year follow-up, the composite endpoint occurred in 151 pts (28.6%). In table 1 are summarized clinical, laboratory and echocardiographic characteristics that at Univariate analysis were significantly correlated with the occurrence of the composite endpoint. In multivariable model, only LVEF (OR 0.97; CI 0.94-0.99; p = 0.029), DDD (OR 1.002; CI 1.0005-1.004; p = 0.011) and NaRS (OR 2.58; CI 1.52-4.39; p <0.001), were independently associated with events. Conclusion: In chronic stable HF patients, DDD appears to have an independent prognostic value. Additional analyses are needed to determine if high DDD may have the same independent predictive value after adjustment for the clinical congestion status of pts.