Prognostic implication of outpatient loop diuretic dose intensification trajectories in patients with chronic heart failure
Background: The relationship between outpatient oral loop diuretic (OLD) dose intensification trajectories and the prognosis of patients with chronic heart failure (CHF) remains unclear. Methods: In 832 patients with CHF, OLD dose trajectories for 1 year were consecutively investigated. OLD dose int...
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Elsevier
2025-04-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906725000351 |
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| author | Toshiharu Koike Atsushi Suzuki Noriko Kikuchi Asami Yoshimura Kaoru Haruki Ayano Yoshida Maiko Sone Mayui Nakazawa Kei Tsukamoto Yasutaka Imamura Hidetoshi Hattori Tomohito Kogure Junichi Yamaguchi Tsuyoshi Shiga |
| author_facet | Toshiharu Koike Atsushi Suzuki Noriko Kikuchi Asami Yoshimura Kaoru Haruki Ayano Yoshida Maiko Sone Mayui Nakazawa Kei Tsukamoto Yasutaka Imamura Hidetoshi Hattori Tomohito Kogure Junichi Yamaguchi Tsuyoshi Shiga |
| author_sort | Toshiharu Koike |
| collection | DOAJ |
| description | Background: The relationship between outpatient oral loop diuretic (OLD) dose intensification trajectories and the prognosis of patients with chronic heart failure (CHF) remains unclear. Methods: In 832 patients with CHF, OLD dose trajectories for 1 year were consecutively investigated. OLD dose intensification was defined as the first occurrence of OLD dose increase from the baseline within the first year. Patients were classified into three groups of OLD dose intensification trajectories: irreversible, reversible, and no intensification. Irreversible intensification was defined as an OLD dose intensification wherein the dose remained above the baseline during the first year of follow-up. Reversible intensification referred to an OLD dose intensification wherein the dose returned to or dropped below the baseline within the first year of follow-up. No intensification was defined as no OLD dose intensification throughout the first year of follow-up. The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular death (CVD), heart failure hospitalisation (HFH), a composite of CVD or HFH, and a composite of all-cause mortality or HFH after 1 year. Results: During the median follow-up (57 [range, 13–102] months), 146 patients died. Irreversible intensification was associated with higher risks of all outcomes than no intensification (e.g., all-cause mortality: hazard ratio [HR], 1.63; 95% confidence interval [CI], 1.08–2.44; HFH: HR, 2.16; 95% CI, 1.65–2.98; CVD or HFH: HR, 2.17; 95% CI, 1.59–2.96). Conversely, reversible intensification had comparable prognoses for all outcomes to no intensification. Conclusion: OLD dose intensification trajectories could stratify the prognosis of CHF patients. |
| format | Article |
| id | doaj-art-bfddb12f861b44bba76bdf75ad531bee |
| institution | DOAJ |
| issn | 2352-9067 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj-art-bfddb12f861b44bba76bdf75ad531bee2025-08-20T03:15:47ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672025-04-015710163210.1016/j.ijcha.2025.101632Prognostic implication of outpatient loop diuretic dose intensification trajectories in patients with chronic heart failureToshiharu Koike0Atsushi Suzuki1Noriko Kikuchi2Asami Yoshimura3Kaoru Haruki4Ayano Yoshida5Maiko Sone6Mayui Nakazawa7Kei Tsukamoto8Yasutaka Imamura9Hidetoshi Hattori10Tomohito Kogure11Junichi Yamaguchi12Tsuyoshi Shiga13Department of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan; Corresponding author at: Department of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.Department of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, JapanDepartment of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, JapanDepartment of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, JapanDepartment of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, JapanDepartment of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, JapanDepartment of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, JapanDepartment of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, JapanDepartment of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, JapanDepartment of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, JapanDepartment of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, JapanDepartment of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, JapanDepartment of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, JapanDepartment of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan; Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo 105-8461, JapanBackground: The relationship between outpatient oral loop diuretic (OLD) dose intensification trajectories and the prognosis of patients with chronic heart failure (CHF) remains unclear. Methods: In 832 patients with CHF, OLD dose trajectories for 1 year were consecutively investigated. OLD dose intensification was defined as the first occurrence of OLD dose increase from the baseline within the first year. Patients were classified into three groups of OLD dose intensification trajectories: irreversible, reversible, and no intensification. Irreversible intensification was defined as an OLD dose intensification wherein the dose remained above the baseline during the first year of follow-up. Reversible intensification referred to an OLD dose intensification wherein the dose returned to or dropped below the baseline within the first year of follow-up. No intensification was defined as no OLD dose intensification throughout the first year of follow-up. The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular death (CVD), heart failure hospitalisation (HFH), a composite of CVD or HFH, and a composite of all-cause mortality or HFH after 1 year. Results: During the median follow-up (57 [range, 13–102] months), 146 patients died. Irreversible intensification was associated with higher risks of all outcomes than no intensification (e.g., all-cause mortality: hazard ratio [HR], 1.63; 95% confidence interval [CI], 1.08–2.44; HFH: HR, 2.16; 95% CI, 1.65–2.98; CVD or HFH: HR, 2.17; 95% CI, 1.59–2.96). Conversely, reversible intensification had comparable prognoses for all outcomes to no intensification. Conclusion: OLD dose intensification trajectories could stratify the prognosis of CHF patients.http://www.sciencedirect.com/science/article/pii/S2352906725000351Heart failureLoop diureticsDose titrationTrajectoryPrognosis |
| spellingShingle | Toshiharu Koike Atsushi Suzuki Noriko Kikuchi Asami Yoshimura Kaoru Haruki Ayano Yoshida Maiko Sone Mayui Nakazawa Kei Tsukamoto Yasutaka Imamura Hidetoshi Hattori Tomohito Kogure Junichi Yamaguchi Tsuyoshi Shiga Prognostic implication of outpatient loop diuretic dose intensification trajectories in patients with chronic heart failure International Journal of Cardiology: Heart & Vasculature Heart failure Loop diuretics Dose titration Trajectory Prognosis |
| title | Prognostic implication of outpatient loop diuretic dose intensification trajectories in patients with chronic heart failure |
| title_full | Prognostic implication of outpatient loop diuretic dose intensification trajectories in patients with chronic heart failure |
| title_fullStr | Prognostic implication of outpatient loop diuretic dose intensification trajectories in patients with chronic heart failure |
| title_full_unstemmed | Prognostic implication of outpatient loop diuretic dose intensification trajectories in patients with chronic heart failure |
| title_short | Prognostic implication of outpatient loop diuretic dose intensification trajectories in patients with chronic heart failure |
| title_sort | prognostic implication of outpatient loop diuretic dose intensification trajectories in patients with chronic heart failure |
| topic | Heart failure Loop diuretics Dose titration Trajectory Prognosis |
| url | http://www.sciencedirect.com/science/article/pii/S2352906725000351 |
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