{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T06:05:08Z","timestamp":1790316308795,"version":"4.1.0"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2020,4,1]],"date-time":"2020-04-01T00:00:00Z","timestamp":1585699200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"},{"start":{"date-parts":[[2020,4,1]],"date-time":"2020-04-01T00:00:00Z","timestamp":1585699200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Guidelines recommend down-titration of loop diuretics (LD) once euvolaemia is achieved. In outpatients with heart failure (HF), we investigated LD dose changes in daily cardiology practice, agreement with guideline recommendations, predictors of successful LD down-titration and association between dose changes and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We included 8130 HF patients from the ESC-EORP Heart Failure Long-Term Registry. Among patients who had dose decreased, successful decrease was defined as the decrease not followed by death, HF hospitalization, New York Heart Association class deterioration, or subsequent increase in LD dose. Mean age was 66\u2009\u00b1\u200913\u2009years, 71% men, 62% HF with reduced ejection fraction, 19% HF with mid-range ejection fraction, 19% HF with preserved ejection fraction. Median [interquartile range (IQR)] LD dose was 40 (25\u201380) mg. LD dose was increased in 16%, decreased in 8.3% and unchanged in 76%. Median (IQR) follow-up was 372 (363\u2013419) days. Diuretic dose increase (vs. no change) was associated with HF death [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.12\u20132.08; P = 0.008] and nominally with cardiovascular death (HR 1.25, 95% CI 0.96\u20131.63; P = 0.103). Decrease of diuretic dose (vs. no change) was associated with nominally lower HF (HR 0.59, 95% CI 0.33\u20131.07; P = 0.083) and cardiovascular mortality (HR 0.62,<\/jats:p>\n                    <jats:p>95% CI 0.38\u20131.00; P = 0.052). Among patients who had LD dose decreased, systolic blood pressure [odds ratio (OR) 1.11 per 10\u2009mmHg increase, 95% CI 1.01\u20131.22; P = 0.032], and absence of (i) sleep apnoea (OR 0.24, 95% CI 0.09\u20130.69; P = 0.008), (ii) peripheral congestion (OR 0.48, 95% CI 0.29\u20130.80; P = 0.005), and (iii) moderate\/severe mitral regurgitation (OR 0.57, 95% CI 0.37\u20130.87; P = 0.008) were independently associated with successful decrease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Diuretic dose was unchanged in 76% and decreased in 8.3% of outpatients with chronic HF. LD dose increase was associated with worse outcomes, while the LD dose decrease group showed a trend for better outcomes compared with the no-change group. Higher systolic blood pressure, and absence of (i) sleep apnoea, (ii) peripheral congestion, and (iii) moderate\/severe mitral regurgitation were independently associated with successful dose decrease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.1796","type":"journal-article","created":{"date-parts":[[2020,4,1]],"date-time":"2020-04-01T05:16:35Z","timestamp":1585718195000},"page":"1424-1437","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":66,"title":["Association Between Loop Diuretic Dose Changes and Outcomes in Chronic Heart Failure: Observations from the ESC-EORP Heart Failure Long-Term Registry"],"prefix":"10.1093","volume":"22","author":[{"given":"Chris J.","family":"Kapelios","sequence":"first","affiliation":[{"name":"Department of Cardiology, Laiko General Hospital , Athens ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9cile","family":"Laroche","sequence":"additional","affiliation":[{"name":"EURObservational Research Programme, European Society of Cardiology , Sophia-Antipolis ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria G.","family":"Crespo-Leiro","sequence":"additional","affiliation":[{"name":"Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna, CHUAC, INIBIC, UDC, CIBERCV , La Coruna ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan D.","family":"Anker","sequence":"additional","affiliation":[{"name":"Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) Partner Site Berlin; Charit\u00e9 Universit\u00e4tsmedizin Berlin , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.S.","family":"Coats","sequence":"additional","affiliation":[{"name":"IRCCS, San Raffaele Pisana , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatria","family":"D\u00edaz-Molina","sequence":"additional","affiliation":[{"name":"Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Hospital Universitario Central de Asturias , Oviedo ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerasimos","family":"Filippatos","sequence":"additional","affiliation":[{"name":"Department of Cardiology, School of Medicine, University of Cyprus & Heart Failure Unit, University Hospital Attikon, National and Kapodistrian Univeristy of Athens , Athens ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitja","family":"Lainscak","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Murska Sobota, Murska Sobota and Faculty of Medicine, University of Ljubljana , Ljubljana ,","place":["Slovenia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aldo P.","family":"Maggioni","sequence":"additional","affiliation":[{"name":"EURObservational Research Programme, European Society of Cardiology , Sophia-Antipolis ,","place":["France"]},{"name":"ANMCO Research Center , Florence ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"McDonagh","sequence":"additional","affiliation":[{"name":"King\u2019s College Hospital , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Mebazaa","sequence":"additional","affiliation":[{"name":"Department of Anesthesia-Burn-Critical Care, UMR 942 Inserm \u2013 MASCOT, University of Paris; APHP Saint Louis Lariboisi\u00e8re University Hospitals , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Metra","sequence":"additional","affiliation":[{"name":"Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda","family":"Moura","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Militar, Porto, Cintesis- Faculty of Medicine, University of Porto , Porto ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilfried","family":"Mullens","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University , Diepenbeek ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo F.","family":"Piepoli","sequence":"additional","affiliation":[{"name":"Heart Failure Unit, Cardiac Department, G. da Saliceto Hospital, AUSL , Piacenza ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe M.C.","family":"Rosano","sequence":"additional","affiliation":[{"name":"IRCCS, San Raffaele Pisana , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Ruschitzka","sequence":"additional","affiliation":[{"name":"Clinic of Cardiology, University Hospital , Z\u00fcrich ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petar M.","family":"Seferovic","sequence":"additional","affiliation":[{"name":"University of Belgrade Faculty of Medicine , Belgrade ,","place":["Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars H.","family":"Lund","sequence":"additional","affiliation":[{"name":"Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Heart Failure Long-Term Registry Investigators Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,4,1]]},"reference":[{"key":"2026011721364114900_ejhf1796-bib-0001","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1093\/ehjcvp\/pvx020","article-title":"Loop diuretics for chronic heart failure: a foe in disguise of a friend?","volume":"4","author":"Kapelios","year":"2018","journal-title":"Eur Heart J Cardiovasc Pharmacother"},{"key":"2026011721364114900_ejhf1796-bib-0002","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1002\/ejhf.1369","article-title":"The use of diuretics in heart failure with congestion \u2013 a position statement from the Heart Failure Association of the European Society of Cardiology","volume":"21","author":"Mullens","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2026011721364114900_ejhf1796-bib-0003","doi-asserted-by":"crossref","first-page":"1624","DOI":"10.1002\/ejhf.945","article-title":"A comprehensive population-based characterization of heart failure with mid-range ejection fraction","volume":"19","author":"Koh","year":"2017","journal-title":"Eur J Heart Fail"},{"key":"2026011721364114900_ejhf1796-bib-0004","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1093\/eurjhf\/hfq154","article-title":"EURObservational Research Programme: the Heart Failure Pilot Survey (ESC-HF Pilot)","volume":"12","author":"Maggioni","year":"2010","journal-title":"Eur J Heart Fail"},{"key":"2026011721364114900_ejhf1796-bib-0005","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1002\/ejhf.1149","article-title":"Heart failure with mid-range ejection fraction in CHARM: characteristics, outcomes and effect of candesartan across the entire ejection fraction spectrum","volume":"20","author":"Lund","year":"2018","journal-title":"Eur J Heart Fail"},{"key":"2026011721364114900_ejhf1796-bib-0006","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1002\/ejhf.592","article-title":"2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). 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