ArticleEuropean journal of heart failure2025
Exploring safety of down-titrating diuretics in heart failure management.
Article in European journal of heart failure, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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.
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.
Who cites it
2 citing papers in PubMed.
- The 'Chloride Theory' for Heart Failure Pathophysiology: An Updated Narrative Review 2025.Cardiology and therapy · 2026Review
- Decongestion in chronic heart failure.JRSM cardiovascular diseaseReview
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
Abstract
aimsLoop diuretics are widely used in heart failure (HF) for symptom relief. Guidelines advise treating patients with the lowest possible dose of loop diuretics to maintain euvolaemia, based on expert opinion only. However, data on the safety of this practice are scarce. This analysis aims to investigate the clinical course after changing loop diuretics in stable HF patients. METHODS AND
resultsA post-hoc analysis from the TIME-CHF study was conducted in 622 patients. Daily loop diuretic doses were meticulously recorded, resulting in 11 035 dose evaluations assessed. The frequency of relevant events within 30 days (hospitalization, death, dose change) following an up-titration, down-titration, or no change in diuretic therapy was calculated. Risk of hospitalization and deaths 30 days after down-titration was estimated after adjusting for congestion level. At baseline the cohort consisted mostly of males (59%), with a mean age of 77 years. Patients were highly symptomatic with 76% classified as New York Heart Association class III or IV. Within 30 days after a down-titration, diuretic dose necessitated an increase in 30.4% of cases, compared with 20.7% following up-titration and 8.0% on a stable dose. Hospitalization and death were significantly more frequent following down-titration (3.4% and 2% within 30 days, respectively) than with a stable dose (1% and 0.6%, p < 0.001). Similar hospitalization rates were observed after up-titration. The risk of hospitalization doubled and of death tripled after down-titration in patients with similar congestion levels.
conclusionsThere is a significant risk that reduction in diuretic dose requires restart or increase of diuretics within a short period. Additionally, there may be a significant risk associated with diuretic dose reduction. Therefore, HF patients need to be closely monitored after down-titration of loop diuretic therapy.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.