Observational studyClinical research in cardiology : official journal of the German Cardiac Society2020
Higher doses of loop diuretics limit uptitration of angiotensin-converting enzyme inhibitors in patients with heart failure and reduced ejection fraction.
Observational study in Clinical research in cardiology : official journal of the German Cardiac Society, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
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Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 34 citations in OpenAlex.
- Effectiveness and safety of chronic diuretic use in older adults: an umbrella review of recently published systematic reviews and meta-analyses of randomized-controlled trials.European geriatric medicine · 2025Pooled it
- The effects of diuretic deprescribing in adult patients: A systematic review to inform an evidence-based diuretic deprescribing guideline.British journal of clinical pharmacology · 2025Pooled it
- Diuretics in Cardiovascular Disease: For How Long and at What Dose?Journal of cardiovascular development and disease · 2026Review
- Impact of socio-demographic and ethnic determinants in guideline-directed medical therapy implementation during heart failure hospitalization.European heart journal open · 2025Article
- Precision Medicine: Therapeutically Targeting Mitochondrial Alterations in Heart Failure.JACC. Basic to translational science · 2025Review
- A Comparison of Different Guidelines for the Treatment of Acute Heart Failure and Their Extensibility to Emergency Departments: A Critical Reappraisal.Journal of clinical medicine · 2025Review
- Observational
- Device-based Strategies for Monitoring Congestion and Guideline-directed Therapy in Heart Failure: The Who, When and How of Personalised Care.Cardiac failure review · 2025Review
- Phenotype and outcomes according to loop diuretic use in pulmonary arterial hypertension.ESC heart failure · 2024Observational
- Article
- The Changing Role of Loop Diuretics in Heart Failure Management across the Last Century.Journal of clinical medicine · 2024Review
- The potential of herbal drugs to treat heart failure: The roles of Sirt1/AMPK.Journal of pharmaceutical analysis · 2024Review
- Use of loop diuretics in patients with chronic heart failure: an observational overview.Open heart · 2023Observational
- Review
- Use of short-acting vs. long-acting loop diuretics after heart failure hospitalization.ESC heart failure · 2022Article
- Impact of Loop Diuretic on Outcomes in Patients with Heart Failure and Reduced Ejection Fraction.Current heart failure reports · 2022Review
- Angiotensin-Converting Enzyme Inhibitor Dose Optimization and Its Associated Factors at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia.Vascular health and risk management · 2022Article
- Intensification of pharmacological decongestion but not the actual daily loop diuretic dose predicts worse chronic heart failure outcome: insights from TIME-CHF.Clinical research in cardiology : official journal of the German Cardiac Society · 2021Article
- Angiotensin Receptor Neprilysin Inhibitors in HFrEF: Is This the First Disease Modifying Therapy Drug Class Leading to a Substantial Reduction in Diuretic Need?International journal of heart failure · 2021Review
- Protected risk stratification with the wearable cardioverter-defibrillator: results from the WEARIT-II-EUROPE registry.Clinical research in cardiology : official journal of the German Cardiac Society · 2021Observational
Corrections and comments
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Authors and funding
17 authors at 11 institutions in 11 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundLoop diuretics are frequently prescribed to patients with heart failure and reduced ejection fraction (HFrEF) for the treatment of congestion; however, they might hamper uptitration of inhibitors of the renin-angiotensin system.
methodsLoop diuretic dose at baseline was recorded in 2338 patients with HFrEF enrolled in BIOSTAT-CHF, an international study of HF patients on loop diuretic therapy who were eligible for uptitration of angiotensin-converting enzyme inhibitors (ACEi)/mineralocorticoid receptor antagonists (MRA). The association between loop diuretic dose and uptitration of ACEi/MRA to percentage of target dose was adjusted for a previously published model for likelihood of uptitration and a propensity score.
resultsBaseline median loop diuretic dose was 40 [40-100] mg of furosemide or equivalent. Higher doses of loop diuretics were associated with higher NYHA class and higher levels of NT-proBNP, more severe signs and symptoms of congestion, more frequent MRA use, and lower doses of ACEi reached at 3 and 9 months (all P < 0.01). After propensity adjustment, higher doses of loop diuretics remained significantly associated with poorer uptitration of ACEi (Beta per log doubling of loop diuretic dose: - 1.66, P = 0.021), but not with uptitration of MRAs (P = 0.758). Higher doses of loop diuretics were independently associated with an increased risk of all-cause mortality or HF hospitalization [HR per doubling of loop diuretic dose: 1.06 (1.01-1.12), P = 0.021].
conclusionsHigher doses of loop diuretics limited uptitration of ACEi in patients with HFrEF and were associated with a higher risk of death and/or HF hospitalization, independent of their lower likelihood of uptitration and higher baseline risk. This figure was created with images adapted from Servier Medical Art licensed under a Creative Commons Attribution 3.0.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.