{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T22:03:37Z","timestamp":1777673017527,"version":"3.51.4"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Loop diuretics are used for congestion relief, and dose adaptations are usually a consequence of the clinicians\u2019 clinical judgement about the congestive status of the patient. In EPHESUS (Eplerenone in Patients With Systolic Dysfunction After Myocardial Infarction), many patients required diuretics for congestion relief. We thus hypothesized that blinded allocation to eplerenone would lead clinicians to reduce loop diuretics, as a consequence of the improvement in patients\u2019 status.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Cox and mixed-effects models were used over a median follow-up of 1.3 years in 6632 patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              A total of 6632 patients were included; at baseline, 3352 (50.5%) did not have diuretics, 2195 (33.1%) had diuretic doses between 1 and 40 mg\/day, and 1085 (16.4%) had diuretic doses &gt;40 mg\/day. Patients with higher furosemide equivalent doses had a worse clinical status. Both baseline and follow-up incremental loop diuretic doses were associated with worse prognosis. Eplerenone treatment was associated with lower prescribed loop diuretic doses throughout the follow-up; lower doses were observed at 90 days and decreased further at 180 days and beyond. Eplerenone treatment led to a mean furosemide equivalent dose reduction of \u22122.2 mg\/day (\u22122.9 to \u22121.6) throughout the follow-up. Eplerenone was effective in reducing morbidity and mortality regardless of the baseline loop diuretic dose used: hazard ratio for the outcome of cardiovascular death or heart failure hospitalization was 0.83 ([95% CI, 0.75\u20130.92];\n              <jats:italic>P<\/jats:italic>\n              for interaction, 0.54).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Eplerenone treatment led to a loop diuretic dose reduction during follow-up without evidence of treatment effect modification by loop diuretics. These findings suggest that eplerenone reduces congestive signs and symptoms, which enables clinicians to reduce loop diuretic doses.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circheartfailure.119.006597","type":"journal-article","created":{"date-parts":[[2020,5,1]],"date-time":"2020-05-01T09:00:39Z","timestamp":1588323639000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Reduced Diuretic Dose in Patients Treated With Eplerenone"],"prefix":"10.1161","volume":"13","author":[{"given":"Jo\u00e3o Pedro","family":"Ferreira","sequence":"first","affiliation":[{"name":"Universite de Lorraine, Clinical Investigation Center 1433, French Clinical Research Infrastructure Network Investigation Network Initiative\u2013Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Regional et Universitaire de Nancy, INSERM Unite 1116 (J.P.F., K. Duarte, N.G., R.F., S.T., F.Z., P.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Romain","family":"Eschalier","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Cardiologie, H\u00f4pital Gabriel Montpied, CHU de Clermont-Ferrand, France (R.E.)."},{"name":"French Clinical Research Infrastructure Network Investigation Network Initiative\u2013Cardiovascular and Renal Clinical Trialists, France (R.E.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Duarte","sequence":"additional","affiliation":[{"name":"Universite de Lorraine, Clinical Investigation Center 1433, French Clinical Research Infrastructure Network Investigation Network Initiative\u2013Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Regional et Universitaire de Nancy, INSERM Unite 1116 (J.P.F., K. Duarte, N.G., R.F., S.T., F.Z., P.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Damman","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands (K. Damman)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Finn","family":"Gustafsson","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (F.G.)."},{"name":"Department of Clinical Medicine (F.G., M.S.), University of Copenhagen, Denmark."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morten","family":"Schou","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine (F.G., M.S.), University of Copenhagen, Denmark."},{"name":"Faculty of Health and Medical Sciences (M.S.), University of Copenhagen, Denmark."},{"name":"Department of Cardiology, Copenhagen University Hospital, Herlev-Gentofte Hospital, Copenhagen, Denmark (M.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolas","family":"Girerd","sequence":"additional","affiliation":[{"name":"Universite de Lorraine, Clinical Investigation Center 1433, French Clinical Research Infrastructure Network Investigation Network Initiative\u2013Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Regional et Universitaire de Nancy, INSERM Unite 1116 (J.P.F., K. Duarte, N.G., R.F., S.T., F.Z., P.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renaud","family":"Fay","sequence":"additional","affiliation":[{"name":"Universite de Lorraine, Clinical Investigation Center 1433, French Clinical Research Infrastructure Network Investigation Network Initiative\u2013Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Regional et Universitaire de Nancy, INSERM Unite 1116 (J.P.F., K. Duarte, N.G., R.F., S.T., F.Z., P.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"St\u00e9phane","family":"Tala","sequence":"additional","affiliation":[{"name":"Universite de Lorraine, Clinical Investigation Center 1433, French Clinical Research Infrastructure Network Investigation Network Initiative\u2013Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Regional et Universitaire de Nancy, INSERM Unite 1116 (J.P.F., K. Duarte, N.G., R.F., S.T., F.Z., P.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bertram","family":"Pitt","sequence":"additional","affiliation":[{"name":"University of Michigan, Ann Arbor (B.P.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faiez","family":"Zannad","sequence":"additional","affiliation":[{"name":"Universite de Lorraine, Clinical Investigation Center 1433, French Clinical Research Infrastructure Network Investigation Network Initiative\u2013Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Regional et Universitaire de Nancy, INSERM Unite 1116 (J.P.F., K. Duarte, N.G., R.F., S.T., F.Z., P.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Rossignol","sequence":"additional","affiliation":[{"name":"Universite de Lorraine, Clinical Investigation Center 1433, French Clinical Research Infrastructure Network Investigation Network Initiative\u2013Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Regional et Universitaire de Nancy, INSERM Unite 1116 (J.P.F., K. Duarte, N.G., R.F., S.T., F.Z., P.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.592"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000435"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31808-7"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1716477"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0735-1097(03)00765-4"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1023\/a:1011119003788"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2015.06.014"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.04.049"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2015.06.013"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.020729"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.114.001957"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1911303"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1291\/hypres.31.1251"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu164"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.028282"}],"container-title":["Circulation: Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCHEARTFAILURE.119.006597","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T01:44:12Z","timestamp":1715564652000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCHEARTFAILURE.119.006597"}},"subtitle":["Data From the EPHESUS Trial"],"short-title":[],"issued":{"date-parts":[[2020,5]]},"references-count":15,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2020,5]]}},"alternative-id":["10.1161\/CIRCHEARTFAILURE.119.006597"],"URL":"https:\/\/doi.org\/10.1161\/circheartfailure.119.006597","relation":{},"ISSN":["1941-3289","1941-3297"],"issn-type":[{"value":"1941-3289","type":"print"},{"value":"1941-3297","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5]]},"assertion":[{"value":"2019-09-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-02-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-05-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e006597"}}