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. 2023 Oct;10(5):2843-2852.
doi: 10.1002/ehf2.14467. Epub 2023 Jul 5.

Diuretic dose is a strong prognostic factor in ambulatory patients awaiting heart transplantation

Guillaume Baudry  1 , Guillaume Coutance  2 , Richard Dorent  3 , Fabrice Bauer  4 , Katrien Blanchart  5 , Aude Boignard  6 , Céline Chabanne  7 , Clément Delmas  8 , Nicolas D'Ostrevy  9 , Eric Epailly  10 , Vlad Gariboldi  11 , Philippe Gaudard  12 , Céline Goéminne  13 , Sandrine Grosjean  14 , Julien Guihaire  15 , Romain Guillemain  16 , Mathieu Mattei  17 , Karine Nubret  18 , Sabine Pattier  19 , Emmanuelle Vermes  20 , Laurent Sebbag  21 , Kevin Duarte  1 , Nicolas Girerd  1
Affiliations

Diuretic dose is a strong prognostic factor in ambulatory patients awaiting heart transplantation

Guillaume Baudry et al. ESC Heart Fail. 2023 Oct.

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.

Keywords: Advanced heart failure; Cardiorenal syndrome; Congestion; Diuretic; Heart transplant.

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Conflict of interest statement

G.B. reports consulting fees from AstraZeneca, Boehringer‐Ingelheim, and Abbott, outside the submitted work. G.C. reports personal fees from Institut de France and Fullbright, outside the submitted work. R.D., C.D., C.G., and J.G. have nothing to disclose. P.G. reports consulting fees or honoraria from Air Liquide Santé International, Abiomed, Amomed, and Abbott and support from Pfizer, outside the submitted work. A.B. has nothing to disclose. M.M. reports honoraria from LFB/Hemosims Cardio, outside the submitted work. E.E., R.G., C.C., K.N., S.P., and V.G. have nothing to disclose. F.B. reports consulting fees or honoraria from Jansen & Jansen, Boehringer, AstraZeneca, and Pfizer, outside the submitted work. E.V., N.O., S.G., and K.B. have nothing to disclose. L.S. reports personal fees or honoraria from Novartis, Vifor, and AstraZeneca, outside the submitted work. K.D. has nothing to disclose. N.G. reports personal fees from AstraZeneca, Bayer, Boehringer, Novartis, and Vifor, outside the submitted work. M.F.S., P.F., and C.A. have nothing to disclose.

Figures

Figure 1
Figure 1
Likelihood of different outcomes according to quartiles of furosemide equivalent dose. LVAD, left ventricular assist device.
See this image and copyright information in PMC

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