0479: Diuretics resistance: caracteristics and outcome at the institut of cardiologie at Abidjan

Objective Analyze the characteristics of heart failure patients with high doses of loop diuretics and can respond to the notion of resistance to diuretics Methods We used the registry hospitalization years 2012 and 2013 the Department of Medicine, Institute of Cardiology of Abidjan. This was a retrospective analysis conducted from 1 January 2012 to 31 December 2013 and which led to the inclusion 490 patients hospitalized for acute heart failure. Data on clinical features, ultrasound, biological and therapeutic were collected. Patients were divided into 3 groups depending on the dose loop diuretics (furosemide) to the prescribed output: G1 (Low doses ≤80mg / day, n=124), G2 (intermediate 81-120mg doses / d, n 98), G3 (high doses> 120mg / day, n = 242) Results Patients in group G3 distinguished by a clinical picture dominated by the overall heart failure, a significant impairment of LVEF (90.9% vs 75.8% and 75.5%), the use of inotropic (24% vs 20.9% and 8.2%), a significant impairment of renal function at the output (19% vs 17.4% and 10.4), hyponatremia (42.9% vs 37 1% and 32.6%), higher levels of natriuretic peptides and a longer hospital stay (5.8±3.4 vs 5.5±3 and 5.7±3.1 days). At decharge, these patients were less frequently an ACE inhibitor or ARA2 (72.7% vs 75.8% and 81.6%) and a beta-blocker (14.8% VS20, 9 and 18.3), but more frequently mineralocorticoid receptor antagonist. Large doses of diuretics to the output was associated with increased mortality in two years Conclusion The use of high doses of diuretics is associated with a profile of severe heart failure and a poor prognosis. The diuretic resistance requires benefit studies to clarify its definition and management