Heart failure & cardiomyopathies
Assessment of Ototoxicity in Patients With Heart Failure Receiving High-Dose IV Loop Diuretics
Authors' conclusion
In this analysis of 2 small HF cohorts, short-term exposure to high-dose LD was not associated with permanent ototoxicity, although concomitant ototoxin use was excluded. Future studies are needed to understand the risk of ototoxicity with repeated LD exposure and in broader HF populations.
Study context
- Population
- Patients with heart failure (HF) receiving IV loop diuretics: outpatients with stable HF (cohort 1) and hospitalized patients with acute HF (cohorts 2 and 3)three cohorts
- Exposure
- Association of loop diuretic (LD) dose with permanent and temporary ototoxicity
- Cohort 1n = 50
- Cohort 2n = 40
- Cohort 3n = 22,656
- Outcome
- Clinically diagnosed ototoxicity and hearing changes via audiometry
Methodological detailsCohort 1: randomized sequence of LD doses across study visits with serial audiometry assessments, Cohort 2: audiometry at baseline and prior to discharge, Cohort 3: retrospective, ICD-10 codes, Cohorts 1 and 2 single center; cohort 3 multicenter
- Cohort 1: randomized sequence of LD doses across study visits with serial audiometry assessments
- Cohort 2: audiometry at baseline and prior to discharge
- Cohort 3: retrospective, ICD-10 codes
- Cohorts 1 and 2 single center; cohort 3 multicenter
Main finding
As reported in the abstract
Estimate (95% CI)P value
Cohort 1, per doubling doseworsening hearing shifts at peak diuretic concentration
OR 1.99 per doubling dose(1.21–3.28)
P = 0.007Cohort 2, per doubling dosehearing shifts
OR 1.19 per doubling dose(0.71–1.98)
P = 0.52Peak dose 160 mg furosemide equivalents or greater (cohort 3) vs Less than 160 mg (cohort 3)clinically diagnosed ototoxicity; multivariable
OR 0.83(0.52–1.31)
P = 0.43Peak dose 400 mg furosemide equivalents or greater (cohort 3) vs Less than 160 mg (cohort 3)clinically diagnosed ototoxicity; multivariable
OR 1.28(0.71–2.31)
P = 0.41- Cohort 1: worsening hearing shifts at peak diuretic concentration
- 24 ears of 400 doses [6%]
- Cohort 1: hearing shifts absent within hours
- 98% of measurements (393 ears of 400 doses)
- Cohort 3: HF hospitalizations with clinically diagnosed ototoxicity
- 608 (2.7%)
Observational data: associations, not effects.
Further findings
Cohort 1 baseline characteristics
- Mean (SD) age
- 63.2 (10.4) years
- Women
- 21 of 50 participants (42%)
Original publication
Assessment of Ototoxicity in Patients With Heart Failure Receiving High-Dose IV Loop Diuretics. JAMA Cardiol. Published 30 October 2026. doi:10.
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