Association of time-to-intravenous furosemide with mortality in acute heart failure: data from REPORT-HF

Wouter Ouwerkerk; Jasper Tromp; John G.F. Cleland; Christiane E. Angermann; Ulf Dahlstrom; Georg Ertl; Mahmoud Hassanein; Sergio V. Perrone; Mathieu Ghadanfar; Anja Schweizer; Achim Obergfell; Kenneth Dickstein; Gerasimos Filippatos; Sean P. Collins; Carolyn S.P. Lam

doi:10.1002/ejhf.2708

Association of time-to-intravenous furosemide with mortality in acute heart failure: data from REPORT-HF

Wouter Ouwerkerk, Jasper Tromp^*, John G.F. Cleland, Christiane E. Angermann, Ulf Dahlstrom, Georg Ertl, Mahmoud Hassanein, Sergio V. Perrone, Mathieu Ghadanfar, Anja Schweizer, Achim Obergfell, Kenneth Dickstein, Gerasimos Filippatos, Sean P. Collins, Carolyn S.P. Lam^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Aim: Acute heart failure can be a life-threatening medical condition. Delaying administration of intravenous furosemide (time-to-diuretics) has been postulated to increase mortality, but prior reports have been inconclusive. We aimed to evaluate the association between time-to-diuretics and mortality in the international REPORT-HF registry.

Methods and results: We assessed the association of time-to-diuretics within the first 24 h with in-hospital and 30-day post-discharge mortality in 15 078 patients from seven world regions in the REPORT-HF registry. We further tested for effect modification by baseline mortality risk (ADHERE risk score), left ventricular ejection fraction (LVEF) and region. The median time-to-diuretics was 67 (25th–75th percentiles 17–190) min. Women, patients with more signs and symptoms of heart failure, and patients from Eastern Europe or Southeast Asia had shorter time-to-diuretics. There was no significant association between time-to-diuretics and in-hospital mortality (p > 0.1). The 30-day mortality risk increased linearly with longer time-to-diuretics (administered between hospital arrival and 8 h post-hospital arrival) (p = 0.016). This increase was more significant in patients with a higher ADHERE risk score (p_interaction = 0.008), and not modified by LVEF or geographic region (p_interaction > 0.1 for both).

Conclusion: In REPORT-HF, longer time-to-diuretics was not associated with higher in-hospital mortality. However, we did found an association with increased 30-day mortality, particularly in high-risk patients, and irrespective of LVEF or geographic region. Clinical Trial Registration: ClinicalTrials.gov Identifier NCT02595814.

Original language	English
Pages (from-to)	43-51
Number of pages	9
Journal	European Journal of Heart Failure
Volume	25
Issue number	1
DOIs	https://doi.org/10.1002/ejhf.2708
Publication status	Published - Jan-2023
Externally published	Yes

Keywords

Diuretics
Heart failure

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Ouwerkerk, W., Tromp, J., Cleland, J. G. F., Angermann, C. E., Dahlstrom, U., Ertl, G., Hassanein, M., Perrone, S. V., Ghadanfar, M., Schweizer, A., Obergfell, A., Dickstein, K., Filippatos, G., Collins, S. P., & Lam, C. S. P. (2023). Association of time-to-intravenous furosemide with mortality in acute heart failure: data from REPORT-HF. European Journal of Heart Failure, 25(1), 43-51. https://doi.org/10.1002/ejhf.2708

@article{6c6504745fba4250be9623f639bcb789,

title = "Association of time-to-intravenous furosemide with mortality in acute heart failure: data from REPORT-HF",

abstract = "Aim: Acute heart failure can be a life-threatening medical condition. Delaying administration of intravenous furosemide (time-to-diuretics) has been postulated to increase mortality, but prior reports have been inconclusive. We aimed to evaluate the association between time-to-diuretics and mortality in the international REPORT-HF registry.Methods and results: We assessed the association of time-to-diuretics within the first 24 h with in-hospital and 30-day post-discharge mortality in 15 078 patients from seven world regions in the REPORT-HF registry. We further tested for effect modification by baseline mortality risk (ADHERE risk score), left ventricular ejection fraction (LVEF) and region. The median time-to-diuretics was 67 (25th–75th percentiles 17–190) min. Women, patients with more signs and symptoms of heart failure, and patients from Eastern Europe or Southeast Asia had shorter time-to-diuretics. There was no significant association between time-to-diuretics and in-hospital mortality (p > 0.1). The 30-day mortality risk increased linearly with longer time-to-diuretics (administered between hospital arrival and 8 h post-hospital arrival) (p = 0.016). This increase was more significant in patients with a higher ADHERE risk score (pinteraction = 0.008), and not modified by LVEF or geographic region (pinteraction > 0.1 for both).Conclusion: In REPORT-HF, longer time-to-diuretics was not associated with higher in-hospital mortality. However, we did found an association with increased 30-day mortality, particularly in high-risk patients, and irrespective of LVEF or geographic region. Clinical Trial Registration: ClinicalTrials.gov Identifier NCT02595814.",

keywords = "Diuretics, Heart failure",

author = "Wouter Ouwerkerk and Jasper Tromp and Cleland, {John G.F.} and Angermann, {Christiane E.} and Ulf Dahlstrom and Georg Ertl and Mahmoud Hassanein and Perrone, {Sergio V.} and Mathieu Ghadanfar and Anja Schweizer and Achim Obergfell and Kenneth Dickstein and Gerasimos Filippatos and Collins, {Sean P.} and Lam, {Carolyn S.P.}",

note = "Funding Information: REPORT‐HF was funded by Novartis. Funding Information: Jasper Tromp is supported by the National University of Singapore start‐up grant, the tier 1 grant from the Singapore Ministry of Education, and the CS‐IRG New Investigator Grant from the National Medical Research. Publisher Copyright: {\textcopyright} 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.",

year = "2023",

month = jan,

doi = "10.1002/ejhf.2708",

language = "English",

volume = "25",

pages = "43--51",

journal = "European Journal of Heart Failure",

issn = "1388-9842",

publisher = "Wiley",

number = "1",

}

Ouwerkerk, W, Tromp, J, Cleland, JGF, Angermann, CE, Dahlstrom, U, Ertl, G, Hassanein, M, Perrone, SV, Ghadanfar, M, Schweizer, A, Obergfell, A, Dickstein, K, Filippatos, G, Collins, SP & Lam, CSP 2023, 'Association of time-to-intravenous furosemide with mortality in acute heart failure: data from REPORT-HF', European Journal of Heart Failure, vol. 25, no. 1, pp. 43-51. https://doi.org/10.1002/ejhf.2708

TY - JOUR

T1 - Association of time-to-intravenous furosemide with mortality in acute heart failure

T2 - data from REPORT-HF

AU - Ouwerkerk, Wouter

AU - Tromp, Jasper

AU - Cleland, John G.F.

AU - Angermann, Christiane E.

AU - Dahlstrom, Ulf

AU - Ertl, Georg

AU - Hassanein, Mahmoud

AU - Perrone, Sergio V.

AU - Ghadanfar, Mathieu

AU - Schweizer, Anja

AU - Obergfell, Achim

AU - Dickstein, Kenneth

AU - Filippatos, Gerasimos

AU - Collins, Sean P.

AU - Lam, Carolyn S.P.

N1 - Funding Information: REPORT‐HF was funded by Novartis. Funding Information: Jasper Tromp is supported by the National University of Singapore start‐up grant, the tier 1 grant from the Singapore Ministry of Education, and the CS‐IRG New Investigator Grant from the National Medical Research. Publisher Copyright: © 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

PY - 2023/1

Y1 - 2023/1

N2 - Aim: Acute heart failure can be a life-threatening medical condition. Delaying administration of intravenous furosemide (time-to-diuretics) has been postulated to increase mortality, but prior reports have been inconclusive. We aimed to evaluate the association between time-to-diuretics and mortality in the international REPORT-HF registry.Methods and results: We assessed the association of time-to-diuretics within the first 24 h with in-hospital and 30-day post-discharge mortality in 15 078 patients from seven world regions in the REPORT-HF registry. We further tested for effect modification by baseline mortality risk (ADHERE risk score), left ventricular ejection fraction (LVEF) and region. The median time-to-diuretics was 67 (25th–75th percentiles 17–190) min. Women, patients with more signs and symptoms of heart failure, and patients from Eastern Europe or Southeast Asia had shorter time-to-diuretics. There was no significant association between time-to-diuretics and in-hospital mortality (p > 0.1). The 30-day mortality risk increased linearly with longer time-to-diuretics (administered between hospital arrival and 8 h post-hospital arrival) (p = 0.016). This increase was more significant in patients with a higher ADHERE risk score (pinteraction = 0.008), and not modified by LVEF or geographic region (pinteraction > 0.1 for both).Conclusion: In REPORT-HF, longer time-to-diuretics was not associated with higher in-hospital mortality. However, we did found an association with increased 30-day mortality, particularly in high-risk patients, and irrespective of LVEF or geographic region. Clinical Trial Registration: ClinicalTrials.gov Identifier NCT02595814.

AB - Aim: Acute heart failure can be a life-threatening medical condition. Delaying administration of intravenous furosemide (time-to-diuretics) has been postulated to increase mortality, but prior reports have been inconclusive. We aimed to evaluate the association between time-to-diuretics and mortality in the international REPORT-HF registry.Methods and results: We assessed the association of time-to-diuretics within the first 24 h with in-hospital and 30-day post-discharge mortality in 15 078 patients from seven world regions in the REPORT-HF registry. We further tested for effect modification by baseline mortality risk (ADHERE risk score), left ventricular ejection fraction (LVEF) and region. The median time-to-diuretics was 67 (25th–75th percentiles 17–190) min. Women, patients with more signs and symptoms of heart failure, and patients from Eastern Europe or Southeast Asia had shorter time-to-diuretics. There was no significant association between time-to-diuretics and in-hospital mortality (p > 0.1). The 30-day mortality risk increased linearly with longer time-to-diuretics (administered between hospital arrival and 8 h post-hospital arrival) (p = 0.016). This increase was more significant in patients with a higher ADHERE risk score (pinteraction = 0.008), and not modified by LVEF or geographic region (pinteraction > 0.1 for both).Conclusion: In REPORT-HF, longer time-to-diuretics was not associated with higher in-hospital mortality. However, we did found an association with increased 30-day mortality, particularly in high-risk patients, and irrespective of LVEF or geographic region. Clinical Trial Registration: ClinicalTrials.gov Identifier NCT02595814.

KW - Diuretics

KW - Heart failure

U2 - 10.1002/ejhf.2708

DO - 10.1002/ejhf.2708

M3 - Article

C2 - 36196060

AN - SCOPUS:85142123577

SN - 1388-9842

VL - 25

SP - 43

EP - 51

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

IS - 1

ER -

Association of time-to-intravenous furosemide with mortality in acute heart failure: data from REPORT-HF

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