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Abstract
Although intravenous diuretics is a cornerstone of acute heart failure treatment (AHF), its optimal initial dose is unclear. This is a post-hoc analysis of the REALITY-AHF, a prospective multicentre observational registry of AHF. The initial intravenous diuretic dose used in each patient was categorised into below, standard, or above the recommended dose groups according to guideline-recommended initial intravenous diuretic dose. The recommended dose was individualised based on the oral diuretic dose taken at admission. We compared the study endpoints, including 60-day mortality, diuretics response within six hours, and length of hospital stay (HS). Of 1093 patients, 429, 558, and 106 were assigned to the Below, Standard, and Above groups, respectively. The diuretics response and HS were significantly greater in the Below group than in the Standard group after adjusting for covariates. Kaplan–Meier analysis indicated a significantly higher incidence of 60-day mortality in the Above group than the Standard group. This difference was retained after adjusting for other prognostic factors. Treatment with a lower than guideline-recommended intravenous diuretic dose was associated with longer HS, whereas above the guideline-recommended dose was associated with a higher 60-day mortality rate. Our results reconfirm that the guideline-recommended initial intravenous diuretic dose is feasible for AHF.
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1 Kameda Medical Center, Department of Cardiology, Chiba, Japan (GRID:grid.414927.d) (ISNI:0000 0004 0378 2140); Tokyo Medical and Dental University, Department of Cardiovascular Medicine, Tokyo, Japan (GRID:grid.265073.5) (ISNI:0000 0001 1014 9130)
2 Juntendo University, Department of Cardiovascular Medicine, Tokyo, Japan (GRID:grid.258269.2) (ISNI:0000 0004 1762 2738); Osaka Medical and Pharmaceutical University, Department of Cardiology, Osaka, Japan (GRID:grid.258269.2)
3 Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan (GRID:grid.27476.30) (ISNI:0000 0001 0943 978X)
4 St. Marianna University School of Medicine, Department of Pharmacology, Kawasaki, Japan (GRID:grid.412764.2) (ISNI:0000 0004 0372 3116)
5 Himeji Cardiovascular Center, Department of Cardiology, Hyogo, Japan (GRID:grid.412764.2)
6 Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan (GRID:grid.413045.7) (ISNI:0000 0004 0467 212X)
7 Fukushima Medical University, Department of Cardiovascular Medicine, Fukushima, Japan (GRID:grid.411582.b) (ISNI:0000 0001 1017 9540)
8 University of Tsukuba, Cardiovascular Division, Faculty of Medicine, Tsukuba, Japan (GRID:grid.20515.33) (ISNI:0000 0001 2369 4728)
9 Kameda Medical Center, Department of Cardiology, Chiba, Japan (GRID:grid.414927.d) (ISNI:0000 0004 0378 2140)
10 Cleveland Clinic, Heart and Vascular Institute, Cleveland, USA (GRID:grid.239578.2) (ISNI:0000 0001 0675 4725)
11 The Sakakibara Heart Institute of Okayama, Department of Cardiology, Okayama, Japan (GRID:grid.413411.2); Juntendo University Faculty of Medicine, Department of Cardiovascular Biology and Medicine, Tokyo, Japan (GRID:grid.258269.2) (ISNI:0000 0004 1762 2738); Juntendo University, Department of Digital Health and Telemedicine R&D, Tokyo, Japan (GRID:grid.258269.2) (ISNI:0000 0004 1762 2738)
12 Toranomon Hospital, Department of Cardiology, Cardiovascular Center, Tokyo, Japan (GRID:grid.410813.f) (ISNI:0000 0004 1764 6940)
13 Tokyo Medical and Dental University, Department of Cardiovascular Medicine, Tokyo, Japan (GRID:grid.265073.5) (ISNI:0000 0001 1014 9130)
14 National Cerebral and Cardiovascular Center, Department of Cardiovascular Medicine, Osaka, Japan (GRID:grid.410796.d) (ISNI:0000 0004 0378 8307)
15 Juntendo University, Department of Cardiovascular Medicine, Tokyo, Japan (GRID:grid.258269.2) (ISNI:0000 0004 1762 2738); Juntendo University School of Medicine, Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan (GRID:grid.258269.2) (ISNI:0000 0004 1762 2738)