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Aims: Guidelines recommend down-titration of loop diuretics (LD) once euvolaemia is achieved. In outpatients with heart failure (HF), we investigated LD dose changes in daily cardiology practice, agreement with guideline recommendations, predictors of successful LD down-titration and association between dose changes and outcomes. Methods and results: We included 8130 HF patients from the ESC-EORP Heart Failure Long-Term Registry. Among patients who had dose decreased, successful decrease was defined as the decrease not followed by death, HF hospitalization, New York Heart Association class deterioration, or subsequent increase in LD dose. Mean age was 66 ± 13 years, 71% men, 62% HF with reduced ejection fraction, 19% HF with mid-range ejection fraction, 19% HF with preserved ejection fraction. Median [interquartile range (IQR)] LD dose was 40 (25–80) mg. LD dose was increased in 16%, decreased in 8.3% and unchanged in 76%. Median (IQR) follow-up was 372 (363–419) days. Diuretic dose increase (vs. no change) was associated with HF death [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.12–2.08; P = 0.008] and nominally with cardiovascular death (HR 1.25, 95% CI 0.96–1.63; P = 0.103). Decrease of diuretic dose (vs. no change) was associated with nominally lower HF (HR 0.59, 95% CI 0.33–1.07; P = 0.083) and cardiovascular mortality (HR 0.62,. 95% CI 0.38–1.00; P = 0.052). Among patients who had LD dose decreased, systolic blood pressure [odds ratio (OR) 1.11 per 10 mmHg increase, 95% CI 1.01–1.22; P = 0.032], and absence of (i) sleep apnoea (OR 0.24, 95% CI 0.09–0.69; P = 0.008), (ii) peripheral congestion (OR 0.48, 95% CI 0.29–0.80; P = 0.005), and (iii) moderate/severe mitral regurgitation (OR 0.57, 95% CI 0.37–0.87; P = 0.008) were independently associated with successful decrease. Conclusion: Diuretic dose was unchanged in 76% and decreased in 8.3% of outpatients with chronic HF. LD dose increase was associated with worse outcomes, while the LD dose decrease group showed a trend for better outcomes compared with the no-change group. Higher systolic blood pressure, and absence of (i) sleep apnoea, (ii) peripheral congestion, and (iii) moderate/severe mitral regurgitation were independently associated with successful dose decrease.
Association between loop diuretic dose changes and outcomes in chronic heart failure: observations from the ESC-EORP Heart Failure Long-Term Registry
Kapelios C. J.;Laroche C.;Crespo-Leiro M. G.;Anker S. D.;Coats A. J. S.;Diaz-Molina B.;Filippatos G.;Lainscak M.;Maggioni A. P.;McDonagh T.;Mebazaa A.;Metra M.;Moura B.;Mullens W.;Piepoli M. F.;Rosano G. M. C.;Ruschitzka F.;Seferovic P. M.;Lund L. H.;Gale C. P.;Beleslin B.;Budaj A.;Chioncel O.;Dagres N.;Danchin N.;Erlinge D.;Emberson J.;Glikson M.;Gray A.;Kayikcioglu M.;Maggioni A.;Nagy K. V.;Nedoshivin A.;Petronio A. -S.;Roos-Hesselink J.;Wallentin L.;Zeymer U.;Crespo-Leiro M.;Anker S.;Mebazaa A.;Coats A.;Filippatos G.;Ferrari R.;Maggioni A. P.;Piepoli M. F.;Goda A.;Diez M.;Fernandez A.;Fruhwald F.;Gatzov P.;Kurlianskaya A.;Hullin R.;Christodoulides T.;Hradec J.;Nielsen O. W.;Nedjar R.;Uuetoa T.;Jimenez J. F. D.;Harjola V. -P.;Logeart D.;Tousoulis D.;Milicic D.;Merkely B.;Amir O.;Shotan A.;Shafie D.;Metra M.;Mirrakhimov E.;Kavoliuniene A.;Erglis A.;Otljanska M.;Kostovska E. S.;DeMarco D. C.;Drozdz J.;Fonseca C.;Chioncel O.;Dekleva M.;Dahlstrom U.;Lainscak M.;Goncalvesova E.;Estrago V.;Bajraktari G.;Auer J.;Ablasser K.;Fruhwald F.;Dolze T.;Brandner K.;Gstrein S.;Poelzl G.;Moertl D.;Reiter S.;Muslibegovic A.;Vasilj M.;Fazlibegovic E.;Cesko M.;Zelenika D.;Palic B.;Pravdic D.;Cuk D.;Vitlianova K.;Katova T.;Kurteva T.;Gatzov P.;Kamenova D.;Antova M.;Krejci J.;Spinar J.;Krupicka J.;Malek F.;Hegarova M.;Lazarova M.;Monhart Z.;Hassanein M.;El Messiry F.;El Shazly A. H.;Elrakshy Y.;Youssef A.;Moneim A. A.;Noamany M.;Dayem T. K. A.;Farag N.;Halawa S. I.;Hamid M. A.;Saleh A.;Ebeid H.;Hanna R.;Louis O.;Enen M. A.;Ibrahim B. S.;Nasr G.;Elbahry A.;Sobhy H.;Ashmawy M.;Gouda M.;Aboleineen W.;Bernard Y.;Meneveau N.;Pillot M.;Morel M.;Seronde M. -F.;Schiele F.;Briand F.;Delahaye F.;Damy T.;Eicher J. -C.;de Groote P.;Fertin M.;Lamblin N.;Isnard R.;Thevenin S.;Hagege A.;Logeart D.;Le Marcis V.;Ly J. -F.;Coisne D.;Lequeux B.;Le Moal V.;Mascle S.;Lotton P.;Behar N.;Donal E.;Ridard C.;Reynaud A.;Basquin A.;Bauer F.;Codjia R.;Galinier M.;Tourikis P.;Stavroula M.;Stefanadis C.;Chrysohoou C.;Kotrogiannis I.;Matzaraki V.;Karavidas A.;Tsitsinakis G.;Kapelios C.;Nanas J.;Kampouri H.;Nana E.;Kaldara E.;Eugenidou A.;Vardas P.;Saloustros I.;Tsaknakis T.;Evangelou S.;Tziourganou H.;Tsaroucha A.;Papadopoulou A.;Douras A.;Polgar L.;Kosztin A.;Nyolczas N.;Nagy A. C.;Halmosi R.;Elber J.;Shotan A.;Fuhrmann A. V.;Amir O.;Romano S.;Marcon S.;Penco M.;Di Mauro M.;Lemme E.;Carubelli V.;Rovetta R.;Metra M.;Bulgari M.;Quinzani F.;Bosi S.;Schiavina G.;Squeri A.;Di Tano G.;Pirelli S.;Ferrari R.;Fucili A.;Passero T.;Musio S.;Di Biase M.;Correale M.;Salvemini G.;Brognoli S.;Zanelli E.;Giordano A.;Agostoni P.;Salvioni E.;Copelli S.;Modena M. G.;Valenti C.;Olaru A.;Bandino S.;Deidda M.;Mercuro G.;Marino P. N.;Di Ruocco M. V.;Piccinino C.;Parrinello G.;Licata G.;Torres D.;Giambanco S.;Busalacchi S.;Arrotti S.;Novo S.;Inciardi R. M.;Pieri P.;Galifi M. A.;Teresi G.;Buccheri D.;Minacapelli A.;Veniani M.;Frisinghelli A.;Priori S. G.;Cattaneo S.;Opasich C.;Gualco A.;Pagliaro M.;Mancone M.;Fedele F.;Cinque A.;Vellini M.;Scarfo I.;Romeo F.;Ferraiuolo F.;Sergi D.;Anselmi M.;Melandri F.;Leci E.;Iori E.;Bovolo V.;Frea S.;Bergerone S.;Botta M.;Canavosio F. G.;Gaita F.;Merlo M.;Cinquetti M.;Sinagra G.;Ramani F.;Fabris E.;Artico J.;Miani D.;Fresco C.;Daneluzzi C.;Proclemer A.;Cicoira M.;Zanolla L.;Marchese G.;Torelli F.;Vassanelli C.;Voronina N.;Tamakauskas V.;Smalinskas V.;Karaliute R.;Petraskiene I.;Rumbinaite E.;Kavoliuniene A.;Brazyte-Ramanauskiene R.;Petraskiene D.;Sinkiewicz W.;Gilewski W.;Pietrzak J.;Orzel T.;Kardaszewicz P.;Lazorko-Piega M.;Mosakowska K.;Bellwon J.;Rynkiewicz A.;Raczak G.;Lewicka E.;Dabrowska-Kugacka A.;Bartkowiak R.;Wozakowska-Kaplon B.;Krzeminski A.;Zabojszcz M.;Grzegorzko A.;Bury K.;Nessler J.;Zalewski J.;Furman A.;Poliwczak A.;Bala A.;Zycinski P.;Rudzinska M.;Jankowski L.;Kasprzak J. D.;Michalak L.;Soska K. W.;Drozdz J.;Huziuk I.;Flis P.;Weglarz J.;Bodys A.;Grajek S.;Straburzynska-Migaj E.;Dankowski R.;Szymanowska K.;Szyszka A.;Nowicka A.;Samcik M.;Wolniewicz L.;Komorowska K.;Poprawa I.;Komorowska E.;Sajnaga D.;Zolbach A.;Abdulkarim A. -F.;Lauko-Rachocka A.;Kaminski L.;Kostka A.;Cichy A.;Ruszkowski P.;Splawski M.;Fitas G.;Szymczyk A.;Serwicka A.;Fiega A.;Zysko D.;Krysiak W.;Szabowski S.;Skorek E.;Pruszczyk P.;Bienias P.;Ciurzynski M.;Welnicki M.;Mamcarz A.;Folga A.;Zielinski T.;Rywik T.;Leszek P.;Sobieszczanska-Malek M.;Kozar-Kaminska K.;Komuda K.;Wisniewska J.;Tarnowska A.;Marchel M.;Opolski G.;Kaplon-Cieslicka A.;Gil R. J.;Mozenska O.;Gil K.;Pawlak A.;Michalek A.;Krzesinski P.;Piotrowicz K.;Stanczyk A.;Skrobowski A.;Ponikowski P.;Jankowska E.;Rozentryt P.;Polonski L.;Nowalany-Kozielska E.;Kuczaj A.;Kalarus Z.;Szulik M.;Klys J.;Prokop-Lewicka G.;Kleinrok A.;TavaresAguiar C.;Ventosa A.;Pereira S.;Faria R.;Chin J.;DeJesus I.;Santos R.;Silva P.;Moreno N.;Lourenco C.;Pereira A.;Castro A.;Andrade A.;OliveiraGuimaraes T.;Martins S.;Placido R.;Lima G.;Brito D.;Francisco A. R.;Proenca M.;Araujo I.;Marques F.;Fonseca C.;Moura B.;Campelo M.;Silva-Cardoso J.;Rodrigues J.;Rangel I.;Martins E.;Peres M.;Marta L.;Severino D.;Durao D.;Leao S.;Magalhaes P.;Moreira I.;Ferreira C.;Araujo C.;Ferreira A.;Baptista A.;Radoi M.;Bicescu G.;Vinereanu D.;Sinescu C. -J.;Macarie C.;Popescu R.;Daha I.;Dan G. -A.;Stanescu C.;Dan A.;Craiu E.;Nechita E.;Christodorescu R.;Otasevic P.;Seferovic P. M.;Simeunovic D.;Ristic A. D.;Celic V.;Pavlovic-Kleut M.;Stojcevski B.;Pencic B.;Stevanovic A.;Andric A.;Simic D.;Asanin M.;Iric-Cupic V.;Jovic M.;Milanov S.;Mitic V.;Atanaskovic V.;Antic S.;Pavlovic M.;Stanojevic D.;Stoickov V.;Ilic S.;DeljaninIlic M.;Petrovic D.;Stojsic S.;Kecojevic S.;Dodic S.;Adic N. C.;Cankovic M.;Stojiljkovic J.;Mihajlovic B.;Radin A.;Radovanovic S.;Krotin M.;Klabnik A.;Pernicky M.;Murin J.;Kovar F.;Kmec J.;Strasek M.;Iskra M. S.;Ravnikar T.;Suligoj N. C.;Fras Z.;Jug B.;Glavic T.;Losic R.;Bombek M.;Krunic B.;Horvat S.;Kovac D.;Rajtman D.;Letonja M.;Winkler R.;Melihen-Bartolic C.;Bartolic A.;Kladnik M.;Pusnik C. S.;Marolt A.;Klen J.;Drnovsek B.;Leskovar B.;Anguita M. J. F.;GallegoPage J. C.;Martinez F. M. S.;Andres J.;Bayes-Genis A.;Mirabet S.;Mendez A.;Garcia-Cosio L.;Leon V.;Gonzalez-Costello J.;Muntane G.;Garay A.;Alcade-Martinez V.;Fernandez S. L.;Rivera-Lopez R.;Fernandez-Alvarez M.;Serrano-Martinez J. L.;Crespo-Leiro M.;Grille-Cancela Z.;Marzoa-Rivas R.;Paniagua-Martin M. J.;Barge-Caballero E.;Gonzalez-Gallarza R. D.;SalvadorMontanes O.;Manjavacas A. M. I.;Conde A. C.;Araujo A.;Soria T.;Gomez-Bueno M.;Cobo-Marcos M.;Alonso-Pulpon L.;SegoviaCubero J.;Sayago I.;Gonzalez-Segovia A.;Briceno A.;Subias P. E.;Cano M. J. R.;Sanchez M. A. G.;Jimenez J. F. D.;Pinilla J. M. G.;de la Villa B. G.;Sahuquillo A.;Marques R. B.;Calvo F. T.;Perez-Martinez M. T.;Garrido-Bravo I. P.;Pastor-Perez F.;Pascual-Figal D. A.;Molina B. D.;Orus J.;Gonzalo F. E.;Bertomeu V.;Valero R.;Martinez-Abellan R.;Quiles J.;Mateo I.;ElAmrani A.;Fernandez-Vivancos C.;Valero D. B.;Almenar-Bonet L.;Sanchez-Lazaro I. J.;Marques-Sule E.;Facila-Rubio L.;Perez-Silvestre J.;Garcia-Gonzalez P.;Garcia-Escriva D.;Pellicer-Cabo A.;de laFuente Galan L.;Diaz J. L.;Platero A. R.;Arias J. C.;Blasco-Peiro T.;Julve M. S.;Sanchez-Insa E.;Portoles-Ocampo A.;Melin M.;Hagglund;Stenberg A.;Lindahl I. -M.;Asserlund B.;Olsson L.;Dahlstrom U.;Afzelius M.;Karlstrom P.;Tengvall L.;Olsson B.;Kalayci S.;Cavusoglu Y.;Gencer E.;Yilmaz M. B.;Gunes H.
2020-01-01
Abstract
Aims: Guidelines recommend down-titration of loop diuretics (LD) once euvolaemia is achieved. In outpatients with heart failure (HF), we investigated LD dose changes in daily cardiology practice, agreement with guideline recommendations, predictors of successful LD down-titration and association between dose changes and outcomes. Methods and results: We included 8130 HF patients from the ESC-EORP Heart Failure Long-Term Registry. Among patients who had dose decreased, successful decrease was defined as the decrease not followed by death, HF hospitalization, New York Heart Association class deterioration, or subsequent increase in LD dose. Mean age was 66 ± 13 years, 71% men, 62% HF with reduced ejection fraction, 19% HF with mid-range ejection fraction, 19% HF with preserved ejection fraction. Median [interquartile range (IQR)] LD dose was 40 (25–80) mg. LD dose was increased in 16%, decreased in 8.3% and unchanged in 76%. Median (IQR) follow-up was 372 (363–419) days. Diuretic dose increase (vs. no change) was associated with HF death [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.12–2.08; P = 0.008] and nominally with cardiovascular death (HR 1.25, 95% CI 0.96–1.63; P = 0.103). Decrease of diuretic dose (vs. no change) was associated with nominally lower HF (HR 0.59, 95% CI 0.33–1.07; P = 0.083) and cardiovascular mortality (HR 0.62,. 95% CI 0.38–1.00; P = 0.052). Among patients who had LD dose decreased, systolic blood pressure [odds ratio (OR) 1.11 per 10 mmHg increase, 95% CI 1.01–1.22; P = 0.032], and absence of (i) sleep apnoea (OR 0.24, 95% CI 0.09–0.69; P = 0.008), (ii) peripheral congestion (OR 0.48, 95% CI 0.29–0.80; P = 0.005), and (iii) moderate/severe mitral regurgitation (OR 0.57, 95% CI 0.37–0.87; P = 0.008) were independently associated with successful decrease. Conclusion: Diuretic dose was unchanged in 76% and decreased in 8.3% of outpatients with chronic HF. LD dose increase was associated with worse outcomes, while the LD dose decrease group showed a trend for better outcomes compared with the no-change group. Higher systolic blood pressure, and absence of (i) sleep apnoea, (ii) peripheral congestion, and (iii) moderate/severe mitral regurgitation were independently associated with successful dose decrease.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11379/532241
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simulazione ASN
Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.
