Diuretic resistance in patients with heart failure: Clinical characteristics and predictors of outcome

Background: Our aim was to study the clinical characteristics and predictors of mortality in heart failure (HF) with diuretic resistance. Methods: We conducted a 5-year retrospective study on 119 HF patients with diuretic resistance at Tikur Anbessa Specialized Teaching Hospital. The primary endpoint was mortality. We compared baseline characteristics and assessed association in patients who received high-dose (>= 120 mg) versus low-dose (<120 mg) furosemide. Bivariate and multivariate logistic regression analyses were done. Results: Patients receiving high-dose diuretic had significantly higher mean values for age and in New York Heart Association Class IV HF and received a larger dose of hydrochlorothiazide than low-dose patients. They also had significantly higher mean values for systolic blood pressure (SBP), hemoglobin, and serum creatinine. There was no significant difference in mortality between the two groups. On multivariate analysis, association with the high-dose diuretic group remained significant for the higher mean value for SBP and serum creatinine. Independent predictors of mortality were anemia (adjusted odds ratio [AOR]: 4.1, 95% confidence interval [CI]: 1.1-15.2, P = 0.04), infective endocarditis (AOR: 4.9, 95% CI: 2.1-25.7, P = 0.01), and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) (AOR: 3.1, 95% CI: 1.1-9.9, P = 0.04). The use of digoxin was associated with lower mortality (AOR: 0.21, 95% CI: 0.06-0.78, P = 0.01). Conclusions: In HF patients with diuretic resistance, anemia, infective endocarditis, and the use of NSAIDs were independently associated with increased mortality, whereas the use of digoxin was associated with reduced mortality. Early identification and treatment of the risk factors could play a role in reducing mortality.