Short-term diuretic withdrawal in stable outpatients with mild heart failure and no fluid retention receiving optimal therapy: a double-blind, multicentre, randomized trial.

Autor:	Rohde LE; Hospital de Clínicas de Porto Alegre and Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, CEP, Porto Alegre, RS, Brazil.; Hospital Moinhos de Vento, Rua Ramiro Barcelos 910, CEP, Porto Alegre, RS, Brazil., Rover MM; Instituto de Cardiologia, Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil., Figueiredo Neto JA; Hospital Universitário da Universidade Federal do Maranhão, São Luis, MA, Brazil., Danzmann LC; Hospital Universitário da Universidade Luterana do Brasil, Canoas, RS, Brazil.; Hospital São Lucas da Pontifícia Universidade Católica, Porto Alegre, RS, Brazil., Bertoldi EG; Hospital Escola da Universidade Federal de Pelotas, Pelotas, RS, Brazil., Simões MV; Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brazil., Silvestre OM; Universidade Federal do Acre, Rio Branco, AC, Brazil., Ribeiro ALP; Hospital da Clinicas e Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil., Moura LZ; Hospital Universitário Cajuru da Pontifícia Universidade Católica, Curitiba, PR, Brazil., Beck-da-Silva L; Hospital de Clínicas de Porto Alegre and Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, CEP, Porto Alegre, RS, Brazil.; Hospital Moinhos de Vento, Rua Ramiro Barcelos 910, CEP, Porto Alegre, RS, Brazil., Prado D; Hospital da Clinicas e Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil., Sant'Anna RT; Instituto de Cardiologia, Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil., Bridi LH; Instituto de Cardiologia, Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil., Zimerman A; Hospital de Clínicas de Porto Alegre and Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, CEP, Porto Alegre, RS, Brazil., Raupp da Rosa P; Hospital São Lucas da Pontifícia Universidade Católica, Porto Alegre, RS, Brazil., Biolo A; Hospital de Clínicas de Porto Alegre and Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, CEP, Porto Alegre, RS, Brazil.
Jazyk:	angličtina
Zdroj:	European heart journal [Eur Heart J] 2019 Nov 21; Vol. 40 (44), pp. 3605-3612.
DOI:	10.1093/eurheartj/ehz554
Abstrakt:	Aims: Although loop diuretics are widely used to treat heart failure (HF), there is scarce contemporary data to guide diuretic adjustments in the outpatient setting. Methods and Results: In a prospective, randomized and double-blind protocol, we tested the safety and tolerability of withdrawing low-dose furosemide in stable HF outpatients at 11 HF clinics in Brazil. The trial had two blindly adjudicated co-primary outcomes: (i) symptoms assessment quantified as the area under the curve (AUC) of a dyspnoea score on a visual-analogue scale evaluated at 4 time-points (baseline, Day 15, Day 45, and Day 90) and (ii) the proportion of patients maintained without diuretic reuse during follow-up. We enrolled 188 patients (25% females; 59 ± 13 years old; left ventricular ejection fraction = 32 ± 8%) that were randomized to furosemide withdrawal (n = 95) or maintenance (n = 93). For the first co-primary endpoint, no significant difference in patients' assessment of dyspnoea was observed in the comparison of furosemide withdrawal with continuous administration [median AUC 1875 (interquartile range, IQR 383-3360) and 1541 (IQR 474-3124), respectively; P = 0.94]. For the second co-primary endpoint, 70 patients (75.3%) in the withdrawal group and 77 patients (83.7%) in the maintenance group were free of furosemide reuse during follow-up (odds ratio for additional furosemide use with withdrawal 1.69, 95% confidence interval 0.82-3.49; P = 0.16). Heart failure-related events (hospitalizations, emergency room visits, and deaths) were infrequent and similar between groups (P = 1.0). Conclusions: Diuretic withdrawal did not result in neither increased self-perception of dyspnoea nor increased need of furosemide reuse. Diuretic discontinuation may deserve consideration in stable outpatients with no signs of fluid retention receiving optimal medical therapy. Clinicaltrials.gov Identifier: NCT02689180. (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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