Evidence map›Paper›PMID 36385396›Full record

ArticleClinical research in cardiology : official journal of the German Cardiac Society2023

Diuretic dose trajectories in dilated cardiomyopathy: prognostic implications.

Vincenzo Nuzzi, Antonio Cannatà, Pierpaolo Pellicori, Paolo Manca, Davide Stolfo, Caterina Gregorio, Giulia Barbati, Daniel I Bromage, Theresa McDonagh, John G F Cleland and 2 more

Erratum issuedOpen access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
0.7field-weighted citation impact, top 29% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 4 citations in OpenAlex.

  1. Article
  2. Review
  3. Review
  4. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors at 6 institutions in 3 countries.

Vincenzo NuzziCardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via Pietro Valdoni 7, 34100, Trieste, Italy.
Antonio CannatàCardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via Pietro Valdoni 7, 34100, Trieste, Italy.
Pierpaolo PellicoriRobertson Centre for Biostatistics, Institute of Health and Wellbeing, Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK.
Paolo MancaCardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via Pietro Valdoni 7, 34100, Trieste, Italy.
Davide StolfoCardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via Pietro Valdoni 7, 34100, Trieste, Italy.
Caterina GregorioBiostatistics Unit, University of Trieste, Trieste, Italy.
Giulia BarbatiBiostatistics Unit, University of Trieste, Trieste, Italy.
Daniel I BromageDepartment of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK.
Theresa McDonaghDepartment of Cardiovascular Science, Faculty of Life Science and Medicine, King's College London, London, UK.
John G F ClelandRobertson Centre for Biostatistics, Institute of Health and Wellbeing, Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK.
Marco Merlo *Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via Pietro Valdoni 7, 34100, Trieste, Italy. marco.merlo79@gmail.com.
Gianfranco Sinagra *Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina (ASUGI), University of Trieste, Via Pietro Valdoni 7, 34100, Trieste, Italy.
University of Trieste · ITKing's College London · GBAzienda Sanitaria Universitaria Integrata di Trieste · ITGlasgow Royal Infirmary · GBImperial College London · GBKarolinska Institutet · SE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundFor patients with heart failure, prescription of loop diuretics (LD) and of higher doses are associated with an adverse prognosis. We investigated LD dose trajectories and their associations with outcomes in patients with dilated cardiomyopathy (DCM).

methodsAssociations between outcomes and both furosemide-equivalent dose (FED) at enrolment and change in FED in the subsequent 24 months were evaluated. According to FED trajectory, patients were classified as (i) dose↑ (FED increase by ≥ 50% or newly initiated); (ii) dose↓ (FED decrease by ≥ 50%); (iii) stable dose (change in FED by < 50%); and (iv) never-users. The primary outcome was all-cause-death/heart transplantation/ventricular-assist-device/heart failure hospitalization. The secondary outcome was all-cause-death/heart transplantation/ventricular-assist-device.

resultsOf 1,131 patients enrolled, 738 (65%) were prescribed LD at baseline. Baseline FED was independently associated with outcome (HR per 20 mg increase: 1.12 [95% CI 1.04-1.22], p = 0.003). Of the 908 with information on FED within 24 months from enrolment, 31% were never-users; 29% were dose↓; 26% were stable dose and 14% were dose↑. In adjusted models, compared to never-users, stable dose had a higher risk of the primary outcome (HR 2.42 [95% CI 1.19-4.93], p = 0.015), while dose↑ had the worst prognosis (HR 2.76 [95% CI 1.27-6.03], p = 0.011). Results were similar for the secondary outcome. Compared to patients who remained on LD, discontinuation of LD (143, 24%) was associated with an improved outcome (HR 0.43 [95% CI 0.28-0.65], p < 0.001).

conclusionsIn patients with DCM, LD use and increasing FED are powerful markers of adverse outcomes. Patients who never receive LD have an excellent prognosis. Among 1131 DCM patients 65% received loop diuretics at enrolment (upper left side). The bar chart on the upper right side shows the categorization in never-users/ dose↓/stable dose/ dose↑ over 24 months of follow-up. At the bottom is reported on the left side of each panel (observation period) the trajectory of LD dose in the four groups (left panel) and in patients who have their LD suspended vs those who continue LD (right panel) in the first two years. On the right side of each panel is shown the incidence of primary outcomes during the subsequent follow-up in the subgroups (outcome assessment).

Indexed as

Cardiomyopathy, DilatedHeart FailureDiureticsFurosemideHumansPrognosisSodium Potassium Chloride Symporter InhibitorsStroke VolumeDiureticsFurosemideSodium Potassium Chloride Symporter InhibitorsDilated cardiomyopathyHeart failureLong-term trajectoriesLoop diureticsPrognostic associations

Identifiers

PMID36385396
PMCPMC9998319
OpenAlexW4309148849

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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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.