Short time to furosemide treatment increases survival in acute heart failure
Time-to-Furosemide Treatment and Mortality in Patients Hospitalized With Acute Heart FailureLiterature - Matsue Y, Damman K, Voors AA, et al. - J Am Coll Cardiol 2017;69:3042-3051.
- Out of 1,291 eligible patients, 481 patients (37.3%) were in the early treatment group and 810 (62.7%) in the non-early treatment group. The median D2F time was 90 minutes (IR: 36-186 minutes).
- Arriving by ambulance and the presence of signs and symptoms of congestion, including orthopnea, jugular venous distension, ARB prescription at admission and a high heart rate, were independently associated with a shorter D2F time.
- The early treatment group had a slightly lower GWTG-HF risk score than the non-early treatment group.
- Although the mortality rate increased as GWTG-HF risk score increased in both groups (P for trend <0.05 for both groups), a lower mortality rate was consistently observed in the early treatment group compared with the non-early treatment group across all quartiles, with the absolute risk difference increasing as the Get With the Guidelines-Heart Failure risk score (GWTG-HF, based on race, age, systolic blood pressure, heart rate, blood urea nitrogen, sodium levels, and the presence of chronic obstructive pulmonary disease) quartile rose (P for trend=0.027).
- Early treatment was associated with lower in-hospital mortality in univariate analysis (OR: 0.36; 95% CI: 0.21 - 0.62; P<0.001) and after adjustment for the GWTG-HF risk score (OR: 0.42; 95% CI: 0.24 -0.72; P<0.001).
- In multivariable analysis, no significant interaction was seen between the early treatment group and the GWTG-HF risk score on in-hospital mortality (P for interaction=0.916), nor with any of the congestion symptoms, arrival with or without ambulance or gender (P for interaction >0.3 for all).
- The association between early treatment and in-hospital mortality did not differ significantly in patients with a history of HF (OR: 0.43; 95% CI: 0.19 - 1.00; P=0.051) and without a history of HF (OR: 0.34; 95% CI: 0.11 - 1.03; P=0.057) (P for interaction=0.738).
- In sensitivity analyses, the association between log D2F time and in-hospital mortality remained statistically significant (OR: 1.31; 95% CI: 1.04 - 1.64; P=0.021 for the logistic regression model and OR: 1.31; 95% CI: 1.01 - 1.71; P=0.045 for the GEE [generalized estimating equation] model).
- In the propensity score analysis, 708 patients were matched based on the propensity score. In-hospital mortality was, once again, lower in the early treatment group compared with that in the non-early treatment group (5.9% vs. 2.5%; P=0.038; OR: 0.41; 95% CI: 0.18 - 0.89; P=0.030).
In a prospective observational study, patients with AHF presenting at the ED with severe congestive symptoms were more likely to be treated early with IV furosemide, and treatment with IV furosemide within 60 min was independently associated with a better in-hospital survival.