Diuretic withdrawal is safe for stable heart failure patients: ReBIC-1 trial

Drug therapy for patients with stable heart failure can be simplified by stopping diuretics, according to late breaking results from the ReBIC-1 trial presented at Heart Failure 2019, a scientific congress of the European Society of Cardiology (ESC). The trial was conducted by the Brazilian Research Network in Heart Failure (ReBIC), which includes 11 tertiary care university hospitals in Brazil.

The eligibility criteria included no or mild symptoms (defined as New York Heart Association functional class I to II), reduced left ventricular ejection fraction (45% or below), no heart failure-related hospital admission within the last six months, and receiving low-dose furosemide (40 to 80 mg per day) for at least six months.

A total of 188 outpatients with stable chronic heart failure were randomly allocated to maintain or withdraw (placebo) the diuretic furosemide. The two primary outcomes were:

·         Patient reported dyspnoea using a visual analogue scale at four time points across 90 days

·         Proportion of patients maintained without additional diuretics during the 90-day follow-up (on top of the randomly allocated diuretic or placebo)

There was no difference between groups in the self-perception of dyspnoea during the 90-day follow-up period. Also, 72 patients (75.3%) in the withdrawal group and 78 patients (83.9%) in the maintenance group were free of furosemide reuse during follow-up (p=0.16).

According to Dr Andréia Biolo, of the Federal University of Rio Grande do Sul and Senior author of the study, 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.”

(Source: ESC)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA