Heart failure & cardiomyopathiesSecondary analysis
Exploring Safety of Down-Titrating Diuretics in Heart Failure Management
- Post-hoc analysis of the TIME-CHF study
Authors' conclusion
There is a significant risk that reduction in diuretic dose requires restart or increase of diuretics within a short period. Additionally, there may be a significant risk associated with diuretic dose reduction.
Study context
- Population
- Stable heart failure (HF) patients on loop diuretics (mean age 77 years, 59% male, 76% NYHA class III or IV)11,035 dose evaluations
- Participants
- 622 patients
- Comparison
- Down-titration vs up-titration vs no change in loop diuretic dose
- Primary endpoint
- Relevant events (hospitalization, death, dose change) after a diuretic dose change
- Follow-up
- 30 days
Primary result
As reported in the abstract
Diuretic dose increase needed · within 30 days
Further findings
| Outcome | Down-titration | Up-titration | Stable dose | P value |
|---|---|---|---|---|
| Hospitalization and death · within 30 days · adjusted for congestion level | ||||
| Hospitalization | 3.4% | Not reported in the abstract | 1% | P < 0.001 |
| Death | 2% | Not reported in the abstract | 0.6% |
Hospitalization and death · within 30 days
- Similar hospitalization rates after up-titration
- Risk of hospitalization doubled and of death tripled after down-titration at similar congestion levels
Original publication
Exploring Safety of Down-Titrating Diuretics in Heart Failure Management. Eur J Heart Fail. Published 2 July 2025. doi:10.1002/ejhf.3714
Summarised from the published abstract; every number is checked against it