Reduced Diuretic Dose in Patients Treated With Eplerenone

• Type: Article in International Scientific Journal
• Date: 2020

Authors

Ferreira, JP (Author) FMUP; Eschalier, R (Author) Other; Duarte, K (Author) Other; Damman, K (Author) Other; Gustafsson, F (Author) Other; Schou, M (Author) Other; Girerd, N (Author) Other; Fay, R (Author) Other; Tala, S (Author) Other; Pitt, B (Author) Other; Zannad, F (Author) Other; Rossignol, P (Author) Other

Journal

Title: Circulation: Heart Failure

Vol. 13 No. 11

ISSN: 1941-3289

Publisher: Wolters Kluwer Health

Other information

Authenticus ID: P-00V-8QW

DOI: 10.1161/circheartfailure.119.006597

Abstract (EN): <jats:sec> <jats:title>Background:</jats:title> <jats:p>Loop diuretics are used for congestion relief, and dose adaptations are usually a consequence of the clinicians¿ clinical judgement about the congestive status of the patient. In EPHESUS (Eplerenone in Patients With Systolic Dysfunction After Myocardial Infarction), many patients required diuretics for congestion relief. We thus hypothesized that blinded allocation to eplerenone would lead clinicians to reduce loop diuretics, as a consequence of the improvement in patients¿ status.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>Cox and mixed-effects models were used over a median follow-up of 1.3 years in 6632 patients.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p> A total of 6632 patients were included; at baseline, 3352 (50.5%) did not have diuretics, 2195 (33.1%) had diuretic doses between 1 and 40 mg/day, and 1085 (16.4%) had diuretic doses >40 mg/day. Patients with higher furosemide equivalent doses had a worse clinical status. Both baseline and follow-up incremental loop diuretic doses were associated with worse prognosis. Eplerenone treatment was associated with lower prescribed loop diuretic doses throughout the follow-up; lower doses were observed at 90 days and decreased further at 180 days and beyond. Eplerenone treatment led to a mean furosemide equivalent dose reduction of ¿2.2 mg/day (¿2.9 to ¿1.6) throughout the follow-up. Eplerenone was effective in reducing morbidity and mortality regardless of the baseline loop diuretic dose used: hazard ratio for the outcome of cardiovascular death or heart failure hospitalization was 0.83 ([95% CI, 0.75¿0.92]; <jats:italic>P</jats:italic> for interaction, 0.54). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>Eplerenone treatment led to a loop diuretic dose reduction during follow-up without evidence of treatment effect modification by loop diuretics. These findings suggest that eplerenone reduces congestive signs and symptoms, which enables clinicians to reduce loop diuretic doses.</jats:p> </jats:sec>

Language: English

Type (Professor's evaluation): Dissemination