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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/25768

Title: Value of routine investigations to predict loop diuretic down-titration success in stable heart failure
Authors: Martens, Pieter
Verbrugge, Frederik H.
Boonen, Levinia
Nijst, Petra
Dupont, Matthias
Mullens, Wilfried
Issue Date: 2018
Abstract: Aims: Guidelines advocate down-titration of loop diuretics in chronic heart failure (CHF) when patients have no signs of volume overload. Limited data are available on the expected success rate of this practice or how routine diagnostic tests might help steering this process. Methods and Results: Fifty ambulatory CHF-patients on stable neurohumoral blocker/diuretic therapy for at least 3 months without any clinical sign of volume overload were prospectively included to undergo loop diuretic down-titration. All patients underwent a similar pre-down-titration evaluation consisting of a dyspnea scoring, physical examination, transthoracic echocardiography (diastolic function, right ventricular function, cardiac filling pressures and valvular disease), blood sample (serum creatinine, plasma NT-pro-BNP and neurohormones). Loop diuretic maintenance dose was subsequently reduced by 50% or stopped if dose was <= 40 mg furosemide equivalents. Successful down-titration was defined as a persistent dose reduction after 30 days without weight increase >1.5 kg or new-onset symptoms of worsening heart failure. At 30-day follow-up, down-titration was successful in 62% (n = 31). In 12/19 patients exhibiting down-titration failure, this occurred within the first week. Physical examination, transthoracic echocardiography and laboratory analysis had limited predictive capability to detect patients with down-titration success/failure (positive likelihood-ratios below 1.5, or area under the curve [AUC] non-statically different from AUC=0.5). Conclusion: Loop diuretic down-titration is feasible in a majority of stable CHF patients in which the treating clinician felt continuation of loops was unnecessary to sustain euvolemia. Importantly, routine diagnostics which suggest euvolemia, have limited diagnostic impact on the post-test probability. (C) 2017 Elsevier B.V. All rights reserved.
Notes: [Martens, Pieter; Verbrugge, Frederik H.; Boonen, Levinia; Nijst, Petra; Dupont, Matthias; Mullens, Wilfried] Ziekenhuis Oost Limburg, Dept Cardiol, Schiepse Bos 6, B-3600 Genk, Belgium. [Martens, Pieter; Nijst, Petra] Hasselt Univ, Doctoral Sch Med & Life Sci, Diepenbeek, Belgium. [Mullens, Wilfried] Hasselt Univ, Biomed Res Inst, Fac Med & Life Sci, Diepenbeek, Belgium.
URI: http://hdl.handle.net/1942/25768
DOI: 10.1016/j.ijcard.2017.10.018
ISI #: 000415822100036
ISSN: 0167-5273
Category: A1
Type: Journal Contribution
Appears in Collections: Research publications

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