Prescription and dosing of diuretics in patients with chronic heart failure in the FAR NHL register

Česká verzia

Authors: Špinarová M. ¹; Špinar J. ¹; Pařenica J. ²; Ludka O. ³; Lábr K. ¹; Krejčí J. ¹; Málek F. ⁴; Ošťádal P. ⁴; Tomandl J. ⁵; Benešová K. ⁶; Jarkovský J. ⁶; Špinarová L. ¹
Authors place of work: I. interní kardioangiologická klinika LF MU a FN u sv. Anny v Brně ¹; Interní kardiologická klinika LF MU a FN Brno ²; Fakultní nemocnice Brno ³; Kardiocentrum, Nemocnice Na Homolce, Praha ⁴; Biochemický ústav, LF MU Brno ⁵; Institut biostatistiky a analýz, LF a PřF MU, Brno ⁶
Published in the journal: Kardiol Rev Int Med 2020, 22(2): 58-62

Summary

Background: Congestive heart failure with reduced ejection fraction is a common clinical condition with a serious prognosis. The treatment focuses on improving the symptoms and preventing the progression of the disease. Diuretics, together with RAAS blockers and beta-blockers provide the basic therapy in most patients with pulmonary or systemic congestion.

Methods: These data come from the FAR NHL register (FARmacology and NeuroHumoraL activation). This is a multicentre database of patients with stable systolic heart failure (EF < 50%) included between November 2014 and November 2015.

Results: A population of 1,100 patients was evaluated, the mean age was 65 years, 80.8% were male. The aetiology of heart failure was ischaemic heart disease (49.7%), dilated cardiomyopathy (41.7%) and other (8.6%). Diuretics were the third most frequently prescribed therapy. Furosemide alone or in combination was the most commonly administered diuretic (80.6%). 746 (67.8%) patients also received verospirone or eplerenone. The prescription of diuretics increased with the severity of the disease according to the NYHA classification (all 87.3%, NYHA I 65.8%, NYHA II 88.2%, NYHA III-IV 95.5%, p<0.001). High doses of furosemide were administered to patients with a higher NYHA classification, lower EF (25 vs. 30%, p<0.001), higher level of NT-proBNP (1,176 vs 378 pg / ml, p<0.001) and higher level of creatinine (102 vs. 93 [mu] mol/l, p<0,001).

Conclusions: These data show the tendency of pharmacological prescription of diuretics, which reflects especially the severity of heart failure and renal functions, and show the importance of an individual attitude to correct dosing for every patient.

Keywords:

pharmacotherapy – heart failure – Diuretics – furosemide – FAR NHL register – target dose

Zdroje

1. Ponikowski P, Voors AA, Anker SD et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37(27): 2129–2200. doi: 10.1093/ eurheartj/ ehw128.

2. Špinar J, Hradec J, Špinarová L et al. Souhrn Doporučených postupů ESC pro diagnostiku a léčbu akutního a chronického srdečního selhání z roku 2016. Připraven Českou kardiologickou společností. Cor Vasa 2016; 58(5): 597–636.

3. Vítovec J, Špinar J, Špinarová L. Novinky ve farmakologické léčbě srdečního selhání. Vnitr Lek 2019; 65(10): 611–619.

4. Špinarová M, Špinar J, Pařenica J et al. Preskripce a dávkování inhibitorů RAAS u pacientů s chronickým srdečním selháním v registru FAR NHL. Vnitr Lek 2019; 65(1): 13–14.

5. Hradec J. Farmakoterapie u chronického srdečního selhání. Remedia 2015; 25(2): 89–94.

6. Lábr K, Špinar J, Pařenica J et al. Betablokátory v registru chronického srdečního selhání FAR NHL. Kardiol Rev Int Med 2017; 19(1): 68–72.

7. Pudil R. Farmakoterapie chronického srdečního selhání. Interní Med 2010; 12(3): 126–130.

8. Mairgani G, Málek F. Diuretika a antagonisté mineralokortikoidních receptorů v terapii chronického srdečního selhání se sníženou ejekční frakcí levé komory. Kardiol Rev Int Med 2017; 19(1): 51–54.

9. Pitt B, Zannad F, Remme WJ et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized aldactone evaluation study investigators. N Engl J Med 1999; 41(10): 709–717. doi: 10.1056/ NEJM199909023411001.

10. Zannad F, McMurray JJ, Krum H et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med 2011; 364(1): 11–21. doi: 10.1056/ NEJMoa1009492.

11. Pitt B, Remme W, Zannad F et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003; 348(14): 1309–1321. doi: 10.1056/ NEJMoa030207.

12. Islam MS. The art and science of using diuretics in the treatment of heart failure in diverse clinical settings. Adv Exp Med Biol 2018; 1067: 47–65. doi: 10.1007/ 5584_2018_182.

13. Kapelios CJ, Laroche C, Crespo-Leiro MG et al. Association between loop diuretic dose changes and outcomes in chronic heart failure: observations from the ESC-EORP Heart Failure Long-Term Registry. Eur J Heart Fail 2020. Ahead of print. doi: 10.1002/ ejhf.1796.

14. Spinar J, Spinarova L, Malek F et al. Prognostic value of NT-proBNP added to clinical parameters to predict two-year prognosis of chronic heart failure patients with mid-range and reduced ejection fraction – a report from FAR NHL prospective registry. PLoS One 2019; 14(3): e0214363. doi: 10.1371/ journal.pone.0214363.

15. Spinarova L, Spinarova M, Pavkova M et al. Prognostic impact of copeptin and mid-regional pro-adrenomedullin in chronic heart failure with regard to comorbidities. J Cardiovasc Dis Diagn 2018; 6: 4. doi: 10.4172/ 2329-9517.1000326.