The association between high-dose diuretics and clinical stability in ambulatory chronic heart failure patients

J Card Fail. 2008 Jun;14(5):388-93. doi: 10.1016/j.cardfail.2008.01.015. Epub 2008 May 27.


Objective: In chronic heart failure (HF), diuretic doses increase as the disease progresses, often after hospitalization for instability, and have been associated with worsening renal function and increased mortality.

Methods and results: A prospective observational analysis of 183 patients in an advanced HF clinic stratified at baseline by diuretic dose (low dose < or = 80 mg, high dose > 80 mg furosemide equivalent) was performed. All patients were followed for 1 year, and the primary outcome was a combined HF event of admission for HF, cardiac transplant, mechanical cardiac support, or death. Compared with patients taking low-dose diuretics (n = 113), patients taking high-dose diuretics (n = 70) had more markers of increased cardiovascular risk and were more likely to have a history of recent instability (33% vs 4.4% in low dose, P < .001). High doses of diuretics were a strong univariate predictor of subsequent HF events (hazard ratio 3.83, 95% confidence interval 1.82-8.54); however, after adjustment for clinical stability, diuretic dose no longer remained significant (hazard ratio 1.53, 95% confidence interval 0.58-4.03).

Conclusion: High-dose diuretics may be more of a marker than a cause of instability. A history of HF stability during the past 6 months is associated with an 80% lower risk of an HF event during the next year, independently of baseline diuretic dose.

Publication types

  • Comparative Study

MeSH terms

  • Ambulatory Care Facilities*
  • Ambulatory Care*
  • Antihypertensive Agents / administration & dosage*
  • Bumetanide / administration & dosage
  • Comorbidity
  • Diuretics / administration & dosage*
  • Female
  • Furosemide / administration & dosage
  • Health Status Indicators
  • Heart Failure / drug therapy*
  • Heart Failure / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Sulfonamides / administration & dosage
  • Torsemide
  • Treatment Outcome


  • Antihypertensive Agents
  • Diuretics
  • Sulfonamides
  • Bumetanide
  • Furosemide
  • Torsemide