{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T18:37:46Z","timestamp":1793385466681,"version":"4.5.0"},"reference-count":21,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T00:00:00Z","timestamp":1701043200000},"content-version":"unspecified","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Servier, the Netherlands"},{"DOI":"10.13039\/501100003246","name":"Dutch Research Council","doi-asserted-by":"crossref","award":["628.011.214"],"award-info":[{"award-number":["628.011.214"]}],"id":[{"id":"10.13039\/501100003246","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2023,11,7]]},"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>This study aimed to evaluate the use and dose of loop diuretics (LDs) across the entire ejection fraction (EF) spectrum in a large, \u2018real-world\u2019 cohort of chronic heart failure (HF) patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A total of 10 366 patients with chronic HF from 34 Dutch outpatient HF clinics were analysed regarding diuretic use and diuretic dose. Data regarding daily diuretic dose were stratified by furosemide dose equivalent (FDE)&gt;80\u2009mg or \u226480\u2009mg. Multivariable logistic regression models were used to assess the association between diuretic dose and clinical features.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In this cohort, 8512 (82.1%) patients used diuretics, of which 8179 (96.1%) used LDs. LD use was highest among HF with reduced EF (HFrEF) patients (81.1%) followed by HF with mild-reduced EF (76.1%) and HF with preserved ejection fraction EF (73.8%, p&lt;0.001). Among all LDs users, the median FDE was 40\u2009mg (IQR: 40\u201380). The results of the multivariable analysis showed that New York Heart Association classes III and IV and diabetes mellitus were one of the strongest determinants of an FDE &gt;80\u2009mg, across all HF categories. Renal impairment was associated with a higher FDE across the entire EF spectrum.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In this large registry of real-world HF patients, LD use was highest among HFrEF patients. Advanced symptoms, diabetes mellitus and worse renal function were significantly associated with a higher diuretic dose regardless of left ventricular ejection fraction.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2023-002497","type":"journal-article","created":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T12:33:20Z","timestamp":1701088400000},"page":"e002497","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Use of loop diuretics in patients with chronic heart failure: an observational overview"],"prefix":"10.1136","volume":"10","author":[{"given":"Niels TB","family":"Scholte","sequence":"first","affiliation":[{"name":"Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7351-3139","authenticated-orcid":false,"given":"Dilan","family":"Aydin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard CM","family":"Linssen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Group Twente, Almelo, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Koudstaal","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Groene Hart Hospital, Gouda, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip C","family":"Rademaker","sequence":"additional","affiliation":[{"name":"Department of Cardiology, ZorgSaam, Terneuzen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter R","family":"Geerlings","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St. Jans Gasthuis Weert, Weert, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco WF","family":"van Gent","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismail","family":"Aksoy","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Admiraal De Ruyter Hospital, Goes, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liane","family":"Oosterom","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Dijklander Hospital, Hoorn, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1159-7802","authenticated-orcid":false,"given":"Eric","family":"Boersma","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Peter","family":"Brunner-La Rocca","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasper J","family":"Brugts","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,11,27]]},"reference":[{"key":"2025081612302374000_10.2.e002497.1","doi-asserted-by":"crossref","first-page":"42","DOI":"10.15420\/ecr.2015.10.01.42","article-title":"Diuretic therapy in heart failure - current approaches","volume":"10","author":"Casu","year":"2015","journal-title":"Eur Cardiol"},{"key":"2025081612302374000_10.2.e002497.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.108.821785"},{"key":"2025081612302374000_10.2.e002497.3","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab368"},{"key":"2025081612302374000_10.2.e002497.4","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1007\/s12471-018-1103-7","article-title":"Real-world heart failure management in 10,910 patients with chronic heart failure in the Netherlands: design and rationale of the chronic heart failure ESC guideline-based cardiology practice quality 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