Clinical findings and survival time in dogs with advanced heart failure

J Vet Intern Med. 2018 May;32(3):944-950. doi: 10.1111/jvim.15126. Epub 2018 Apr 10.


Background: Dogs with advanced heart failure are a clinical challenge for veterinarians but there are no studies reporting clinical features and outcome of this population.

Hypothesis/objectives: To describe clinical findings and outcome of dogs with advanced heart failure caused by degenerative mitral valve disease (DMVD).

Animals: Fifty-four dogs with advanced heart failure because of DMVD.

Methods: For study purposes, advanced heart failure was defined as recurrence of congestive heart failure signs despite receiving the initially prescribed dose of pimobendan, angiotensin-converting-enzyme inhibitor (ACEI), and furosemide >4 mg/kg/day. Data were collected for the time of diagnosis of Stage C heart failure and time of diagnosis of advanced heart failure. Date of death was recorded.

Results: At the diagnosis of advanced heart failure, doses of pimobendan (n = 30), furosemide (n = 28), ACEI (n = 13), and spironolactone (n = 4) were increased, with ≥1 new medications added in most dogs. After initial diagnosis of advanced heart failure, 38 (70%) dogs had additional medications adjustments (median = 2 [range, 0-27]), with the final total medication number ranging from 2-10 (median = 5). Median survival time after diagnosis of advanced heart failure was 281 days (range, 3-885 days). Dogs receiving a furosemide dose >6.70 mg/kg/day had significantly longer median survival times (402 days [range, 3-885 days] versus 129 days [range 9-853 days]; P = .017).

Conclusions and clinical importance: Dogs with advanced heart failure can have relatively long survival times. Higher furosemide dose and non-hospitalization were associated with longer survival.

Keywords: cardiology; degenerative mitral valve disease; furosemide; survival.

MeSH terms

  • Animals
  • Cardiotonic Agents / therapeutic use
  • Dog Diseases / drug therapy
  • Dog Diseases / mortality*
  • Dogs
  • Female
  • Furosemide / therapeutic use
  • Heart Failure / drug therapy
  • Heart Failure / etiology
  • Heart Failure / mortality
  • Heart Failure / veterinary*
  • Male
  • Mitral Valve Insufficiency / complications
  • Mitral Valve Insufficiency / mortality
  • Mitral Valve Insufficiency / veterinary
  • Pyridazines / therapeutic use
  • Spironolactone / therapeutic use
  • Survival Analysis
  • Treatment Outcome


  • Cardiotonic Agents
  • Pyridazines
  • Spironolactone
  • pimobendan
  • Furosemide