Prevalence and outcome of diuretic resistance in heart failure

Intern Emerg Med. 2019 Jun;14(4):529-537. doi: 10.1007/s11739-018-02019-7. Epub 2019 Jan 4.

Abstract

Diuretic resistance (DR) is common in patients with decompensated heart failure (HF), and is associated with adverse outcomes. To determine the prevalence of DR and its impact on survival among patients with decompensated HF, we prospectively evaluated the prevalence and influence on prognosis of DR (defined as persistent congestion despite ≥ 80 mg of furosemide per day) in a cohort of elderly patients from the Spanish HF registry (RICA) admitted for an acute decompensation of HF. Patients with new-onset HF were excluded. From the global cohort of 2067 patients, 435 (21%; 95% CI 19.3%-22.7%) patients met criteria for DR. Patients with DR had more comorbidities (hypercholesterolemia, diabetes mellitus, valvular disease, chronic kidney disease, and cancer) and a worse functional status compared to patients without DR. In addition, patients with DR had a higher proportion of ischemic etiology, more advanced functional class and lower left ventricular ejection fraction values. After 1 year of follow-up, all-cause mortality was higher in patients with DR with an adjusted hazard ratio of 1.37 (95% CI 1.06-1.79; p = 0.018). The prevalence of DR in a cohort of elderly patients admitted for acute HF decompensation is 21%. DR is an independent predictor of 1-year mortality.

Keywords: Diuretics; Furosemide; Heart failure.

MeSH terms

  • Aged
  • Analysis of Variance
  • Chi-Square Distribution
  • Drug Resistance / physiology*
  • Female
  • Furosemide / metabolism
  • Furosemide / therapeutic use
  • Heart Failure / drug therapy*
  • Heart Failure / physiopathology
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Prevalence*
  • Prognosis
  • Registries / statistics & numerical data
  • Retrospective Studies
  • Sodium Potassium Chloride Symporter Inhibitors / metabolism*
  • Sodium Potassium Chloride Symporter Inhibitors / therapeutic use
  • Spain

Substances

  • Sodium Potassium Chloride Symporter Inhibitors
  • Furosemide