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Loop diuretic adjustments in patients with chronic heart failure: Insights from HF-ACTION.

BACKGROUND: The relationship between diuretic use or change in diuretic use and outcomes in chronic heart failure (HF) remains poorly defined. We evaluated the association between diuretic use and changes in health status, exercise capacity, and clinical events in a large randomized trial of subjects with HF. METHODS: HF-ACTION randomized 2,331 outpatients with HF and ejection fraction .05). A dose increase was associated with decrease in 6-minute walk distance (-4.25 m, SE 1.12 m, P<.001) and change in Kansas City Cardiomyopathy Questionnaire overall score (-0.56 m, SE 0.24 m, P=.02). There were no between-group differences for all-cause death or hospitalization comparing continuous use versus never use (adjusted HR 0.91; 95% CI 0.72-1.15; P=.432). CONCLUSIONS: The initiation or discontinuation of diuretics over a 6-month time frame was not associated with a difference in mortality, hospitalizations, exercise, or health status outcomes, but a dose increase in HF patients was associated with worse exercise and health status outcomes.

Authors: Fudim, Marat; O'Connor, Christopher M; Mulder, Hillary; Coles, Adrian; Bhatt, Ankeet S; Ambrosy, Andrew P; Kraus, William E; Pina, Ileana L; Whellan, David J; Mentz, Robert J

Am Heart J. 2018 Nov;205:133-141. doi: 10.1016/j.ahj.2018.06.017. Epub 2018 Jul 29.

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