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Recent News and Articles on the Keywords: heart failure + high-dose diuretic + diuretics  Related to the article below (Last Update: 5/5/2008)

Lisinopil: Drug Whys
EMS1.com - Emergency Medical Service Resources, CA - Apr 28, 2008
For treatment of heart failure in adults, initial oral dosing is 2.5 to 5 milligrams once daily adjusted at two to four week intervals by blood pressure ...
Source: Google News

Diuretic efficacy of high dose furosemide in severe heart failure: Bolus injection versus continuous … -
TPJ Dormans, JJM van Meyel, PGG Gerlag, Y Tan, FGM … - Journal of the American College of Cardiology, 1996 - Elsevier
Page 1. 376 JACC Vol. 28, No. 2 August 1996:376-82 Diuretic Etficacy of High Dose
Furosemide in Severe Heart Failure: Bolus Injection Versus Continuous Infusion ...

Spironolactone in congestive heart failure refractory to high-dose loop diuretic and low-dose … -
AA van Vliet, AJ Donker, JJ Nauta, FW Verheugt - Am J Cardiol, 1993 - ncbi.nlm.nih.gov
Spironolactone in congestive heart failure refractory to high-dose loop diuretic
and low-dose angiotensin-converting enzyme inhibitor. ...

Aldosterone escape during angiotensin-converting enzyme inhibitor therapy in chronic heart failure -
AD Struthers - Journal of Cardiac Failure, 1996 - Elsevier
... high dose loop diuretic and low dose ACE inhibitor. Am J Cardiol 1993; 71:21A-8A
56. Garg R, Yusuf S: Current and ongoing randornised trials in heart failure ...

Diuretic resistance predicts mortality in patients with advanced heart failure. -
GW Neuberg, AB Miller, CM O'Connor, RN Belkin, PE … - American Heart Journal, 2002 - pt.wkhealth.com
... In patients with chronic heart failure (CHF), diuretic ... The prognostic importance
of diuretic resistance (as evidenced by a high-dose requirement) was ...

Diuretics, Mortality, and Nonrecovery of Renal Function in Acute Renal Failure -
RL Mehta, MT Pascual, S Soroko, GM Chertow - JAMA, 2002 - Am Med Assoc
... Neither a history of congestive heart failure nor the presence of cardiac organ
system failure explained the ... risk associated with a high dose equivalent per ...

Health outcomes associated with antihypertensive therapies used as first-line agents. A systematic … -
BM Psaty, NL Smith, DS Siscovick, TD Koepsell, NS … - JAMA, 1997 - Am Med Assoc
... The findings were similar for high-dose diuretic therapy (for stroke, RR, 0.49;
95% CI, 0.39-0.62; and for congestive heart failure, RR, 0.17; 95% CI, 0.07-0.41 ...

Diuretics and Risk of Arrhythmic Death in Patients With Left Ventricular Dysfunction -
HA Cooper, DL Dries, CE Davis, YL Shen, MJ … - Circulation, 1999 - Am Heart Assoc
... last strategy on survival in patients with severe heart failure will be ... The hypertension
literature strongly suggests that only high-dose diuretic therapy has ...

[CITATION] The effect of cardiac resynchronization on morbidity and mortality in heart failure -
JG Cleland, JC Daubert, E Erdmann, N Freemantle, D … - New England Journal of Medicine, 2005 - unknown
... effect of cardiac resynchronization on heart failure 1543 * NYHA denotes New York
Heart Association, and ACE ... A high-dose loop diuretic consisted of ...

… high-dose furosemide and hydrochlorothiazide in the treatment of refractory congestive heart failure -
TPJ Dormans, PGG Gerlag - European Heart Journal, 1996 - Eur Soc Cardiology
... describing this synergism in patients with severe congestive heart failure and advanced
renal fail- ure showing diuretic resistance to high-dose furosemide. ...

… diagnosis and treatment of acute heart failure The Task Force on Acute Heart Failure of the European … -
MS Nieminen, M Bohm, MR Cowie, H Drexler, GS … - European Heart Journal, 2005 - Eur Soc Cardiology
... furosemide is superior to high dose diuretic treatment alone. ... was reported that
intravenous high dose nitrate was ... in patients with severe heart failure, and in ...

Source: Google Scholar

High-dose diuretics raise mortality in heart failure

NEW YORK (Reuters Health) - As the dosage of loop diuretics increases in patients with advanced heart failure, the risk of death also increases, according to findings of a study conducted at the University of California at Los Angeles.

"This is the very first study to look specifically at the relationship between various doses of loop diuretics and mortality," lead investigator Dr. Gregg C. Fonarow told Reuters Health."When studying whether a medication may be contributing to adverse clinical outcomes in a patient population," he noted, demonstrating whether or not the relationship is dose dependent is critical."

Diuretics are a class of commonly prescribed drugs that are used to treat heart disease and other illnesses. The drugs stimulate the kidneys to remove more water from the body, which is then passed through the urine. Loop diuretics are a strong type of diuretics.

Fonarow and his colleagues studied a group of 1,354 patients with advanced heart failure receiving treatment at their institution between 1985 and 2004. The average age was 53 years, 76 percent were male and the heart's ability to pump blood was reduced to an average of 24 percent.

The investigators divided the group into four sections, according to loop diuretic dosage. The four groups were similar in terms of age, gender, body mass index, cause of heart failure, history of high blood pressure and previous use of the diuretic spironolactone. The highest dose group had, on average, the lowest ability to pump blood, a well as lower levels of sodium and hemoglobin levels and higher levels of biomarkers of kidney disease.

As reported in the June 15th issue of the American Journal of Cardiology, there was a decrease in survival with increasing dose of loop diuretic. Survival estimates at 2 years were 83 percent with the lowest dose, 81 percent in the second group, 68 percent in the third group and 53 percent in the highest group.

Even after the data were adjusted to remove the effects factors that could also increase mortality -- including age, strength of other drug treatments, kidney function, smoking history and blood pressure -- diuretic dosage remained an independent predictor of mortality. For the high-dose group compared with the low-dose group, the mortality risk was increased by four-fold, the team reports.

Fonarow offered an explanation for the link between loop diuretics and mortality in heart failure. Loop diuretics, especially when given at higher doses, activate a part of the nervous system known to increase the risk of death in heart failure patients. Loop diuretics, especially at higher doses, can also contribute to worsened kidney function and electrolyte abnormalities.

Nonetheless, "loop diuretics currently are one of the only therapies for heart failure patients for the treatment of congestion along with dietary sodium restriction," Fonarow acknowledged.

He recommends that physician use loop diuretics at the lowest dose possible dose to relieve congestion. Some physicians (in the study) favored using higher than necessary doses of loop diuretics to keep their heart failure patients' free of fluid. 'This study suggests that this practice should be avoided."

SOURCE: The American Journal of Cardiology

 

Women often stop asthma therapy in early pregnancy

NEW YORK (Reuters Health) - Many women significantly reduce their use of asthma medications in early pregnancy, placing them and their infants at risk, according to a report in the July issue of American Journal of Obstetrics and Gynecology. However, national treatment guidelines recommend continued use of these potentially life-saving drugs.

"Many women will assume that continued use of asthma medications during pregnancy is bad and will discontinue their medications on their own," Dr. Tina V. Hartert from Vanderbilt University School of Medicine, Nashville, Tennessee told Reuters Health.

Hartert and colleagues used data from more than 8,000 pregnant women with asthma who were enrolled in the Tennessee Medicaid program to investigate whether women alter their use of asthma medications during pregnancy.

By 13 weeks of pregnancy, the use of inhaled anti-inflammatory drugs had fallen by 22.9 percent; the use of short-acting beta-agonist, such as albuterol, for quick relief of symptoms, had fallen by 13.2 percent; and the use of rescue corticosteroids (steroids) had decreased by 54.3 percent, the authors report. The use of all classes of asthma medication increased from weeks 6 to 13 and from weeks 13 to 26 of pregnancy, the researchers note, but only the use of short-acting beta-agonists showed a statistically significant rebound by week 26.

"The results of this study suggest that women on Medicaid decrease and/or stop asthma medications during early pregnancy despite national guidelines recommending continued use," the investigators conclude.

Both primary care physicians, as well as providers that care for women during pregnancy, should educate women early and frequently about the importance of continuing to control their asthma and ensure that they are using appropriate medication," Hartert said.

"Pregnant women already know that they are 'eating for two'; a useful message is that they are also 'breathing for two.'"

"The Bureau of TennCare (Tennessee Medicaid) now requires managed care organizations to provide disease management to both high-risk pregnant women and high-risk asthmatics," Hartert explained. "While asthma during pregnancy has not been specifically addressed, we hope that publication of this peer-reviewed study will communicate the risks identified in this paper to managed care organizations."

 
 
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