Diuretic Response in Acute Heart Failure: An Analysis from ASCEND-HF

March 16, 2015, 9:45 - 10:30 AM

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Disclosures

Faculty Disclosures

Authors

Jozine Ter Maaten, Allison Dunning, Mattia A.E. Valente, Kevin Damman, Justin Ezekowitz, Robert Califf, Randall Starling, Christopher O'Connor, Phillip Schulte, Jeffrey Testani, Adrian Hernandez, Wai Hong Tang, Adriaan Voors, Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands, Duke Clinical Research Institute, Durham, NC, USA

Abstract

Background

Nesiritide is continued to be used in patients with acute heart failure. This study aims to investigate the effects of nesiritide on diuretic response early after admission for acute heart failure.

Methods

Diuretic response, defined as weight loss per 40 mg furosemide or equivalent, was examined from hospital admission to 48 hours in 4,379 patients from the ASCEND-HF trial.

Results

Mean diuretic response was -0.42 kg/40 mg furosemide [IQR -1.0, -0.05]. Poor responders had lower blood pressure, more frequent diabetes, chronic use of loop diuretics, poorer baseline renal function, and lower urine output (all P<0.01). Nesiritide was not associated with diuretic response (P=0.987). Good diuretic response was independently associated with a significant decreased risk in 30 day all cause mortality or rehospitalization (OR 0.44 [0.29-0.65] for highest vs lowest quintile, P<0.001) and 30 day cardiac death or rehospitalization (OR 0.52 [0.36-0.75] for highest vs lowest quintile, P<0.001). As a sensitivity analysis diuretic response based on urine output per 40 mg furosemide from admission to 24 hours was investigated, identifying an association with worse renal function and no significant association with nesiritide treatment (P=0.110).

Conclusion

Poor diuretic response early in hospitalization 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.