Factors influencing the dose of loop diuretics in patients with systolic heart failure at discharge from the hospital

Abstract Aim. Systolic heart failure (HF) is a chronic disease, associated with use of many drugs. Diuretics, particularly loop diuretics, are frequently prescribed to patients hospitalized with HF, and kept thereafter. However, diuretics are a group of drugs, which do not provide mortality benefit in HF, and, may bring about some risks, except in a specific group. Hence, it is important to understand the reasons driving physicians to use them. We retrospectively reviewed the hospital discharge records of HF patients. Methods. 700 patients with systolic HF were reviewed. Loop diuretic, furosemide, dose at disharge was classified into two categories as moderate-high (>40 mg/day) and low doses. Results. 613 patients were prescribed furosemide at discharge. Poor functional capacity (FC) (NYHA FC III-IV) at discharge (B=1.894), serum creatinine levels (B=1.567), and spironolactone prescription (B=2.427) were found to be independently associated with moderate-high dose of furosemide prescription during discharge. Conclusion. Diuretics are inevitable in systolic HF. Reasons driving the physicians to prescribe higher doses might be important in drawing pathways towards lower risks. Key words: Systolic heart failure, loop diuretics, dose at discharge Ozet Amac. Sistolik kalp yetersizligi pek cok ilacin kullanildigi kronik bir hastaliktir. Diuretikler, ozellikle kivrim diuretikleri, hastanaye yatirisan kalp yetersizligi hastalarina siklikla baslanir ve sonrasinda devam ettirilir. Bununla birlikte diuretikler kalp yetersizliginde mortalite faydasi olmayan, bir ozel grup haricinde bi takim riskleri beraberinde getiren ilac grubudur. Bu yuzden hekimlerin neden bu ilaclarini kullandiklarini anlamak onemlidir. Biz bu calismada kalp yetersizligi hastalarinin hastaneden taburculuk raporlarini geriye dogru inceledik.  Yontem. Sistolik kalp yetersizligi olan 700 hasta gozden gecirildi kivrim diuretigi, furosemid, hastane cikisindaki dozu orta-yuksek (>40mg /gun) ve dusuk doz seklinde siniflandirildi. Bulgular. Taburculuk esnasinda 613 hastaya furosemid recetelenmisti. Cikista kotu fonksiyonel sinif (NYHA FK III-IV) (B=1.894), kreatinin (B=1.567) ve spironolakton recetelenmesi (B=2.427) cikista orta yuksek doz furosemid recetelenmesi ile bagimsiz iliskili parametreler olarak bulundu. Sonuc. Diuretikler kalp yetersizliginde kacinilmaz ilaclardir. Hekimleri yuksek doz recetelemeye sevk eden nedenlerin anlasilmasi, daha dusuk riskli yollara yonelmek icin onem olabilir. Anahtar sozcukler: Sistolik kalp yetersizligi, kivrim diuretikleri, taburculuk esnasindaki doz