Loop diuretic suspension in Chronic Heart Failure patients - a retrospective study

Abstract

Background: The use of loop diuretics is central in managing congestion in Heart failure (HF), but their impact on prognosis remains unclear. In euvolemic patients, dose reduction is recommended, but there is no recommendation on their suspension. This study aims to evaluate the impact of loop diuretic discontinuation on prognosis of outpatients with HF with reduced ejection fraction. Methods: This retrospective cohort study collected data from medical records of patients followed in an outpatient HF Clinic at a University Hospital Centre. Patients were included if they had been on loop diuretics, and these were suspended. Demographical, clinical and laboratory data were collected, and worsening heart failure (WHF) events number and type during 1-year after suspension were registered. Results: Amongst 265 patients on loop diuretics, almost half (129) suspended them at some point. Patients had optimized medical therapy, low median age, low New York Heart Association class, low B-type Natriuretic Peptide values, normal blood pressure, controlled heart rate and kidney function within normal limits. Among 122 patients with 1-year of follow-up, 18 (14.8%) had an event. Fifteen events (83.3%) were a low dose diuretic reinitiation at a scheduled visit. Excluding these, there were 3 WHF events (2.5%) during 1-year. A significant improvement in kidney function from suspension to 1-year follow-up appointment was also observed. Conclusions: In our cohort, loop diuretic discontinuation was possible and safe in a large proportion of patients. Results must be interpreted with caution and cannot be extrapolated to a broader population of HF patients.