Spot Urinary Analysis to Assess Loop Diuretic Efficiency in Stable Heart Failure

Not Applicable

Terminated

Brief Summary: The primary objective of this study is to assess whether the urinary sodium/creatinine or chloride/creatinine ratio might predict successful downtitration of loop diuretics in patients with stable heart failure without clinical signs of volume overload. In addition, this study will provide information on loop diuretic efficiency and urinary electrolyte composition after intake of diuretics in stable outpatients with heart failure.

Recruitment & Eligibility

Inclusion Criteria

Patient has a left ventricular ejection fraction <40% or has been previously hospitalized with a primary diagnosis of heart failure
Patient receives a daily maintenance dose of loop diuretics

Exclusion Criteria

Patient was hospitalized for heart failure <3 months before study inclusion
The maintenance dose of loop diuretics was changed <3 months before study inclusion
The maintenance dose of renin-angiotensin-aldosterone system blockers or beta-blocker medication was changed <3 months before study inclusion
Cardiac resynchronization therapy (CRT) was initiated <3 months before study inclusion
At the moment of inclusion, the patient has either one of the following signs of volume overload: lower leg edema +2/4, ascites, lung congestion
Patient is not able to measure his/her weight safely and correct at home

Arm && Interventions

Group	Intervention	Description
Loop diuretic downtitration	Weight monitoring	Scheduled downtitration of maintenance loop diuretic dose while monitoring weight
Loop diuretic downtitration	Loop diuretic downtitration	Scheduled downtitration of maintenance loop diuretic dose while monitoring weight

Primary Outcome Measures

Name	Time	Method
Number of Participants With Successful Downtitration of Loop Diuretics (no Weight Increase >1,5 kg)	7 days after baseline	After baseline evaluation, loop diuretics are temporarily downtitrated or stopped for 7 consecutive days. The patient is instructed to measure his/her weight in the morning of these days, immediately after waking up, on the same balance. In case of weight increase \>1,5 kg, the original dose of diuretics is restored. To check this, patients are contacted by phone after 3 and 7 days. If the patient has not gained \>1,5 kg of weight after 7 days, loop diuretics are considered to be successfully downtitrated.

Secondary Outcome Measures

Name	Time	Method
Number of Participants Rehospitalized for Heart Failure	30 days after baseline	Unplanned hospital admission for symptoms of congestion and/or low output heart failure requiring either intravenous therapy and/or increase of oral diuretics.
All-cause Mortality	30 days after baseline
Number of Participants Requiring a Dose Increase in Loop Diuretics	30 days after baseline	Dose increase of oral maintenance therapy with loop diuretics compared to the final dose achieved in the study 7 days after baseline.
Weight Change	7 days after baseline	Weight change \[kg\] 7 days after baseline compared to baseline weight.