Trial concludes withdrawal of furosemide safe in patients with stable chronic heart failure

A 90-day double-blind randomised trial involving 188 patients with chronic but stable heart failure assessed the safety and tolerability of withdrawing the diuretic furosemide. 50% of the patients continued on furosemide and 50% were given a placebo. Patients’ levels of dyspnoea were assessed four times, and the number of patients who requested additional diuretics to that administered was monitored. The two groups demonstrated the same self-perception of their dyspnoea during the 90 days. 83.9% of patients on furosemide and 75.3% of patients given a placebo were free of furosemide reuse during follow-up. Two patients died in the furosemide group, and there were three heart failure hospitalisations or emergency room visits. There were five heart failure hospitalisations or emergency room visits in the placebo group. The researchers therefore concluded that stopping diuretics was generally well tolerated in patients with chronic but stable heart failure, and they should have their diuretic use reconsidered.
Andréia Biolo, a researcher at the Federal University of Rio Grande do Sul, Brazil, said: “The results show that patients with stable heart failure who stop diuretics do not have more dyspnoea than those who continue taking the drug. Withdrawal also does not lead to increased reuse of diuretics. Around 20% of patients in both groups needed a top-up, presumably for symptom relief….Patients should be educated to seek medical help if they become breathless, get oedema, or have sudden weight gain which indicates fluid retention.”