Also, 72 patients (75%) in the withdrawal group and 78 patients (84%) in the maintenance group did not require furosemide reuse during the 90-day follow-up, the study authors said. The findings were reported this week at a meeting of the European Society of Cardiology, in Athens, Greece.
“Heart failure patients have many pills to take for their heart failure and for [other illnesses], such as diabetes and hypertension,” Rohde said in a society news release. “Withdrawing one drug when it is no longer necessary should make it easier to take the ones that are needed,” he added.
According to study senior author Andreia Biolo, “The results show that patients with stable heart failure who stop diuretics do not have more (shortness of breath) than those who continue taking the drug.” Biolo is also with the Federal University of Rio Grande do Sul.
“Withdrawal also does not lead to increased reuse of diuretics — [only] around 20% of patients in both groups needed a top-up, presumably for symptom relief,” Biolo noted in the news release.
Overall, the study also found that “patients can be followed-up in the usual way,” she said. “And, as we do now, patients should be educated to seek medical help if they become breathless, get edema [swelling], or have sudden weight gain, which indicates fluid retention.”
But Imam wasn’t convinced that diuretics can be eliminated so easily.
In his experience, “even if patients miss diuretics for a few doses, they get recurrent symptoms and feel better almost immediately on resuming them, even in patients with stable heart failure,” he said.
Imam believes the study “is a radical diversion from traditional thinking and most clinicians would … continue using diuretics to treat stable congestive heart failure.”
But another U.S. heart failure specialist was more encouraged by the Brazilian findings.
Dr. Marrick Kukin directs heart failure care at Lenox Hill Hospital in New York City. He agreed that “diuretic withdrawal in heart failure patients is an important goal.”
Kukin said, “If it can be done safely, patients are more comfortable (less urination), and there is less jeopardy to the kidney.”