Usually in stable and asymptomatic patient with reduced ejection fraction the judgment
to suspend or not diuretic therapy purely depend on clinical and intuitive evaluation
and not on objective parameters. In clinical practice diuretic treatment in stable
heart failure with reduced ejection fraction (HFrEF) patients is being used without
clear evidence of major benefit on cardiovascular morbidity and mortality, due to
the absence of adequately sized trials addressing these questions. In our study we
support the concept that diuretics withdrawal should be performed in this HFrEF patients
especially when adequate fluid balance is achieved [
[1]
]. This could not be the case of the aforementioned study [
2
,
3
] for several reasons: In that study clinical data as well as critical echocardiographic
measurements such as left ventricular ejection fraction, as well as other were not
reported, so HF type (reduced vs preserved EF) and grading were not inferable. Finally,
cardiac remodeling state or an estimate of cardiac filling pressures was not reported
as well, so that no one can conclude study populations are indeed comparable.Keywords
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References
- Is diuretic withdrawal safe in patients with heart failure and reduced ejection fraction? A retrospective analysis of our outpatients cohort.Eur J Intern Med. 2017; 42: e11-e13
- Reducing the dose of diuretics for heart failure patients: how low can it go?.Cardiology. 2009; 114: 89
- Triple therapy can achieve striking reductions in frusemide dosage.Cardiology. 2009; 114: 271
Article info
Publication history
Published online: September 14, 2017
Accepted:
September 12,
2017
Received:
September 11,
2017
Identification
Copyright
© 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
