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Randomized Controlled Trial
. 2007 Oct;9(10):1064-9.
doi: 10.1016/j.ejheart.2007.07.011. Epub 2007 Aug 24.

Relation between dose of loop diuretics and outcomes in a heart failure population: results of the ESCAPE trial

Vic Hasselblad  1 , Wendy Gattis Stough, Monica R Shah, Yuliya Lokhnygina, Christopher M O'Connor, Robert M Califf, Kirkwood F Adams Jr
Affiliations
Randomized Controlled Trial

Relation between dose of loop diuretics and outcomes in a heart failure population: results of the ESCAPE trial

Vic Hasselblad et al. Eur J Heart Fail. 2007 Oct.

Abstract

Background: We examined the relation of maximal in-hospital diuretic dose to weight loss, changes in renal function, and mortality in hospitalised heart failure (HF) patients.

Methods: In ESCAPE, 395 patients received diuretics in-hospital. Weight was measured at baseline, discharge, and every other day before discharge. Weight loss was defined as the difference between baseline and last in-hospital weight. Mortality was assessed using a log-logistic model with non-zero background.

Results: Median weight loss: 2.8 kg (0.7, 6.1); mean: 3.7 kg (22% of values <0). Weight loss and maximum in-hospital dose were correlated (p=0.0007). Baseline weight, length of stay, and baseline brain natriuretic peptide were significant predictors of weight loss. After adjusting for these, dose was not a significant predictor of weight loss. A strong relation between dose and mortality was seen (p=0.003), especially at >300 mg/day. Dose remained a significant predictor of mortality after adjusting for baseline variables that significantly predicted mortality. Correlation between maximal dose and creatinine level change was not significant (r=0.043; p=0.412)

Conclusions: High diuretic doses during HF hospitalisation are associated with increased mortality and poor 6-month outcome.

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Figures

Figure 1
Figure 1
Individual weight loss as a function of maximum in-hospital diuretic dose.
Figure 2
Figure 2
Mortality as a function of maximum in-hospital diuretic dose.
Figure 3
Figure 3
Relation of maximal diuretic dose to discharge serum creatinine level.
See this image and copyright information in PMC

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