| Diuretic resistance predicts mortality in patients with advanced heart failure. | |
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MedLine Citation:
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PMID: 12094185 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: In patients with chronic heart failure (CHF), diuretic requirements increase as the disease progresses. Because diuretic resistance can be overcome with escalating doses, the evaluation of CHF severity and prognosis may be incomplete without considering the intensity of therapy. METHODS: The prognostic importance of diuretic resistance (as evidenced by a high-dose requirement) was retrospectively evaluated in 1153 patients with advanced CHF who were enrolled in the Prospective Randomized Amlodipine Survival Evaluation (PRAISE). The relation of loop diuretic and angiotensin-converting enzyme inhibitor doses (defined by their median values) and other baseline characteristics to total and cause-specific mortality was determined by proportion hazards regression. RESULTS: High diuretic doses were independently associated with mortality, sudden death, and pump failure death (adjusted hazard ratios [HRs] 1.37 [P =.004], 1.39 [P =.042], and 1.51 [P =.034], respectively). Use of metolazone was an independent predictor of total mortality (adjusted HR = 1.37, P =.016) but not of cause-specific mortality. Low angiotensin-converting enzyme inhibitor dose was an independent predictor of pump failure death (adjusted HR = 2.21, P =.0005). Unadjusted mortality risks of congestion and its treatment were additive and comparable to those of established risk factors. CONCLUSIONS: The independent association of high diuretic doses with mortality suggests that diuretic resistance should be considered an indicator of prognosis in patients with chronic CHF. These retrospective observations do not establish harm or rule out a long-term benefit of diuretics in CHF, because selection bias may entirely explain the relation of prescribed therapy to death. |
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Authors:
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Gerald W Neuberg; Alan B Miller; Chris M O'Connor; Robert N Belkin; Peter E Carson; Anne B Cropp; David J Frid; Regina G Nye; Milton L Pressler; John H Wertheimer; Milton Packer; |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: American heart journal Volume: 144 ISSN: 1097-6744 ISO Abbreviation: Am. Heart J. Publication Date: 2002 Jul |
Date Detail:
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Created Date: 2002-07-02 Completed Date: 2002-07-18 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0370465 Medline TA: Am Heart J Country: United States |
Other Details:
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Languages: eng Pagination: 31-8 Citation Subset: AIM; IM |
Affiliation:
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Division of Circulatory Physiology, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Amlodipine / therapeutic use* Analysis of Variance Angiotensin-Converting Enzyme Inhibitors / administration & dosage* Chronic Disease Diuretics / administration & dosage* Drug Resistance Female Heart Failure / drug therapy*, mortality* Humans Male Prognosis Regression Analysis Retrospective Studies Vasodilator Agents / therapeutic use* |
| Chemical | |
Reg. No./Substance:
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0/Angiotensin-Converting Enzyme Inhibitors; 0/Diuretics; 0/Vasodilator Agents; 88150-42-9/Amlodipine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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