Diuretic response in acute heart failure—an analysis from ASCEND-HF
Diuretic unresponsiveness often occurs during hospital admission for acute heart failure (AHF) and is associated with adverse outcome. This study aims to investigate determinants, clinical outcome, and the effects of nesiritide on diuretic response early after admission for AHF. Diuretic response, d...
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| Published in | The American heart journal Vol. 170; no. 2; pp. 313 - 321.e4 |
|---|---|
| Main Authors | , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
01.08.2015
Elsevier Limited |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0002-8703 1097-6744 1097-6744 |
| DOI | 10.1016/j.ahj.2015.05.003 |
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| Abstract | Diuretic unresponsiveness often occurs during hospital admission for acute heart failure (AHF) and is associated with adverse outcome. This study aims to investigate determinants, clinical outcome, and the effects of nesiritide on diuretic response early after admission for AHF.
Diuretic response, defined as weight loss per 40 mg of furosemide or equivalent, was examined from hospital admission to 48 hours in 4,379 patients from the ASCEND-HF trial. As an additional analysis, a urinary diuretic response metric was investigated in 5,268 patients using urine volume from hospital admission to 24 hours per 40 mg of furosemide or equivalent.
Mean diuretic response was −0.42 kg/40 mg of furosemide (interquartile range −1.0, −0.05). Poor responders had lower blood pressure, more frequent diabetes, long-term use of loop diuretics, poorer baseline renal function, and lower urine output (all P < .01). Randomized nesiritide treatment was not associated with diuretic response (P = .987). Good diuretic response was independently associated with a significantly decreased risk of 30-day all-cause mortality or heart failure rehospitalization (odds ratio 0.44, 95% CI 0.29-0.65, highest vs lowest quintile, P < .001). Diuretic response based on urine output per 40 mg of furosemide showed similar results in terms of clinical predictors, association with outcome, and the absence of an effect of nesiritide.
Poor diuretic response early after hospital admission for AHF is associated with low blood pressure, renal impairment, low urine output, and an increased risk of death or rehospitalization early after discharge. Nesiritide had a neutral effect on diuretic response. |
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| AbstractList | Diuretic unresponsiveness often occurs during hospital admission for acute heart failure (AHF) and is associated with adverse outcome. This study aims to investigate determinants, clinical outcome, and the effects of nesiritide on diuretic response early after admission for AHF.
Diuretic response, defined as weight loss per 40 mg of furosemide or equivalent, was examined from hospital admission to 48 hours in 4,379 patients from the ASCEND-HF trial. As an additional analysis, a urinary diuretic response metric was investigated in 5,268 patients using urine volume from hospital admission to 24 hours per 40 mg of furosemide or equivalent.
Mean diuretic response was −0.42 kg/40 mg of furosemide (interquartile range −1.0, −0.05). Poor responders had lower blood pressure, more frequent diabetes, long-term use of loop diuretics, poorer baseline renal function, and lower urine output (all P < .01). Randomized nesiritide treatment was not associated with diuretic response (P = .987). Good diuretic response was independently associated with a significantly decreased risk of 30-day all-cause mortality or heart failure rehospitalization (odds ratio 0.44, 95% CI 0.29-0.65, highest vs lowest quintile, P < .001). Diuretic response based on urine output per 40 mg of furosemide showed similar results in terms of clinical predictors, association with outcome, and the absence of an effect of nesiritide.
Poor diuretic response early after hospital admission for AHF is associated with low blood pressure, renal impairment, low urine output, and an increased risk of death or rehospitalization early after discharge. Nesiritide had a neutral effect on diuretic response. Diuretic unresponsiveness often occurs during hospital admission for acute heart failure (AHF) and is associated with adverse outcome. This study aims to investigate determinants, clinical outcome, and the effects of nesiritide on diuretic response early after admission for AHF.BACKGROUNDDiuretic unresponsiveness often occurs during hospital admission for acute heart failure (AHF) and is associated with adverse outcome. This study aims to investigate determinants, clinical outcome, and the effects of nesiritide on diuretic response early after admission for AHF.Diuretic response, defined as weight loss per 40 mg of furosemide or equivalent, was examined from hospital admission to 48 hours in 4,379 patients from the ASCEND-HF trial. As an additional analysis, a urinary diuretic response metric was investigated in 5,268 patients using urine volume from hospital admission to 24 hours per 40 mg of furosemide or equivalent.METHODSDiuretic response, defined as weight loss per 40 mg of furosemide or equivalent, was examined from hospital admission to 48 hours in 4,379 patients from the ASCEND-HF trial. As an additional analysis, a urinary diuretic response metric was investigated in 5,268 patients using urine volume from hospital admission to 24 hours per 40 mg of furosemide or equivalent.Mean diuretic response was -0.42 kg/40 mg of furosemide (interquartile range -1.0, -0.05). Poor responders had lower blood pressure, more frequent diabetes, long-term use of loop diuretics, poorer baseline renal function, and lower urine output (all P < .01). Randomized nesiritide treatment was not associated with diuretic response (P = .987). Good diuretic response was independently associated with a significantly decreased risk of 30-day all-cause mortality or heart failure rehospitalization (odds ratio 0.44, 95% CI 0.29-0.65, highest vs lowest quintile, P < .001). Diuretic response based on urine output per 40 mg of furosemide showed similar results in terms of clinical predictors, association with outcome, and the absence of an effect of nesiritide.RESULTSMean diuretic response was -0.42 kg/40 mg of furosemide (interquartile range -1.0, -0.05). Poor responders had lower blood pressure, more frequent diabetes, long-term use of loop diuretics, poorer baseline renal function, and lower urine output (all P < .01). Randomized nesiritide treatment was not associated with diuretic response (P = .987). Good diuretic response was independently associated with a significantly decreased risk of 30-day all-cause mortality or heart failure rehospitalization (odds ratio 0.44, 95% CI 0.29-0.65, highest vs lowest quintile, P < .001). Diuretic response based on urine output per 40 mg of furosemide showed similar results in terms of clinical predictors, association with outcome, and the absence of an effect of nesiritide.Poor diuretic response early after hospital admission for AHF is associated with low blood pressure, renal impairment, low urine output, and an increased risk of death or rehospitalization early after discharge. Nesiritide had a neutral effect on diuretic response.CONCLUSIONSPoor diuretic response early after hospital admission for AHF is associated with low blood pressure, renal impairment, low urine output, and an increased risk of death or rehospitalization early after discharge. Nesiritide had a neutral effect on diuretic response. Diuretic unresponsiveness often occurs during hospital admission for acute heart failure (AHF) and is associated with adverse outcome. This study aims to investigate determinants, clinical outcome, and the effects of nesiritide on diuretic response early after admission for AHF. Diuretic response, defined as weight loss per 40 mg of furosemide or equivalent, was examined from hospital admission to 48 hours in 4,379 patients from the ASCEND-HF trial. As an additional analysis, a urinary diuretic response metric was investigated in 5,268 patients using urine volume from hospital admission to 24 hours per 40 mg of furosemide or equivalent. Mean diuretic response was -0.42 kg/40 mg of furosemide (interquartile range -1.0, -0.05). Poor responders had lower blood pressure, more frequent diabetes, long-term use of loop diuretics, poorer baseline renal function, and lower urine output (all P < .01). Randomized nesiritide treatment was not associated with diuretic response (P = .987). Good diuretic response was independently associated with a significantly decreased risk of 30-day all-cause mortality or heart failure rehospitalization (odds ratio 0.44, 95% CI 0.29-0.65, highest vs lowest quintile, P < .001). Diuretic response based on urine output per 40 mg of furosemide showed similar results in terms of clinical predictors, association with outcome, and the absence of an effect of nesiritide. Poor diuretic response early after hospital admission for AHF is associated with low blood pressure, renal impairment, low urine output, and an increased risk of death or rehospitalization early after discharge. Nesiritide had a neutral effect on diuretic response. Background Diuretic unresponsiveness often occurs during hospital admission for acute heart failure (AHF) and is associated with adverse outcome. This study aims to investigate determinants, clinical outcome, and the effects of nesiritide on diuretic response early after admission for AHF. Methods Diuretic response, defined as weight loss per 40 mg of furosemide or equivalent, was examined from hospital admission to 48 hours in 4,379 patients from the ASCEND-HF trial. As an additional analysis, a urinary diuretic response metric was investigated in 5,268 patients using urine volume from hospital admission to 24 hours per 40 mg of furosemide or equivalent. Results Mean diuretic response was -0.42 kg/40 mg of furosemide (interquartile range -1.0, -0.05). Poor responders had lower blood pressure, more frequent diabetes, long-term use of loop diuretics, poorer baseline renal function, and lower urine output (allP< .01). Randomized nesiritide treatment was not associated with diuretic response (P= .987). Good diuretic response was independently associated with a significantly decreased risk of 30-day all-cause mortality or heart failure rehospitalization (odds ratio 0.44, 95% CI 0.29-0.65, highest vs lowest quintile,P< .001). Diuretic response based on urine output per 40 mg of furosemide showed similar results in terms of clinical predictors, association with outcome, and the absence of an effect of nesiritide. Conclusions Poor diuretic response early after hospital admission for AHF is associated with low blood pressure, renal impairment, low urine output, and an increased risk of death or rehospitalization early after discharge. Nesiritide had a neutral effect on diuretic response. Background Diuretic unresponsiveness often occurs during hospital admission for acute heart failure (AHF) and is associated with adverse outcome. This study aims to investigate determinants, clinical outcome, and the effects of nesiritide on diuretic response early after admission for AHF. Methods Diuretic response , defined as weight loss per 40 mg of furosemide or equivalent, was examined from hospital admission to 48 hours in 4,379 patients from the ASCEND-HF trial. As an additional analysis, a urinary diuretic response metric was investigated in 5,268 patients using urine volume from hospital admission to 24 hours per 40 mg of furosemide or equivalent. Results Mean diuretic response was −0.42 kg/40 mg of furosemide (interquartile range −1.0, −0.05). Poor responders had lower blood pressure, more frequent diabetes, long-term use of loop diuretics, poorer baseline renal function, and lower urine output (all P < .01). Randomized nesiritide treatment was not associated with diuretic response ( P = .987). Good diuretic response was independently associated with a significantly decreased risk of 30-day all-cause mortality or heart failure rehospitalization (odds ratio 0.44, 95% CI 0.29-0.65, highest vs lowest quintile, P < .001). Diuretic response based on urine output per 40 mg of furosemide showed similar results in terms of clinical predictors, association with outcome, and the absence of an effect of nesiritide. Conclusions Poor diuretic response early after hospital admission for AHF is associated with low blood pressure, renal impairment, low urine output, and an increased risk of death or rehospitalization early after discharge. Nesiritide had a neutral effect on diuretic response. |
| Author | ter Maaten, Jozine M. Dunning, Allison M. Damman, Kevin O'Connor, Christopher M. Hernandez, Adrian F. Califf, Robert M. Voors, Adriaan A. Testani, Jeffrey M. Valente, Mattia A.E. Tang, W.H. Wilson Schulte, Phillip J. Starling, Randall C. van der Meer, Peter Ezekowitz, Justin A. |
| Author_xml | – sequence: 1 givenname: Jozine M. surname: ter Maaten fullname: ter Maaten, Jozine M. organization: University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands – sequence: 2 givenname: Allison M. surname: Dunning fullname: Dunning, Allison M. organization: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC – sequence: 3 givenname: Mattia A.E. surname: Valente fullname: Valente, Mattia A.E. organization: University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands – sequence: 4 givenname: Kevin surname: Damman fullname: Damman, Kevin organization: University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands – sequence: 5 givenname: Justin A. surname: Ezekowitz fullname: Ezekowitz, Justin A. organization: Mazankowski Alberta Heart Institute, Edmonton, Canada – sequence: 6 givenname: Robert M. surname: Califf fullname: Califf, Robert M. organization: Duke Translational Medicine Institute, Durham, NC – sequence: 7 givenname: Randall C. surname: Starling fullname: Starling, Randall C. organization: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC – sequence: 8 givenname: Peter surname: van der Meer fullname: van der Meer, Peter organization: University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands – sequence: 9 givenname: Christopher M. surname: O'Connor fullname: O'Connor, Christopher M. organization: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC – sequence: 10 givenname: Phillip J. surname: Schulte fullname: Schulte, Phillip J. organization: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC – sequence: 11 givenname: Jeffrey M. surname: Testani fullname: Testani, Jeffrey M. organization: Department of Internal Medicine and Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT – sequence: 12 givenname: Adrian F. surname: Hernandez fullname: Hernandez, Adrian F. organization: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC – sequence: 13 givenname: W.H. Wilson surname: Tang fullname: Tang, W.H. Wilson organization: Cleveland Clinic Foundation, Cleveland, OH – sequence: 14 givenname: Adriaan A. surname: Voors fullname: Voors, Adriaan A. email: a.a.voors@umcg.nl organization: University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/26299229$$D View this record in MEDLINE/PubMed |
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| Copyright | 2015 Elsevier Inc. Elsevier Inc. Copyright © 2015 Elsevier Inc. All rights reserved. Copyright Elsevier Limited Aug 2015 |
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| Snippet | Diuretic unresponsiveness often occurs during hospital admission for acute heart failure (AHF) and is associated with adverse outcome. This study aims to... Background Diuretic unresponsiveness often occurs during hospital admission for acute heart failure (AHF) and is associated with adverse outcome. This study... |
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| SubjectTerms | Acute Disease Aged Cardiovascular Classification Diabetes Disease Progression Diuretics Diuretics - administration & dosage Dose-Response Relationship, Drug Double-Blind Method Female Follow-Up Studies Furosemide - administration & dosage Heart attacks Heart failure Heart Failure - drug therapy Heart Failure - epidemiology Heart Failure - physiopathology Hospital Mortality - trends Hospitalization Humans Incidence Male Middle Aged Mortality Patient Admission - statistics & numerical data Retrospective Studies Studies Survival Rate - trends Treatment Outcome United States - epidemiology Urine Variables |
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| Title | Diuretic response in acute heart failure—an analysis from ASCEND-HF |
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