Journal of Cardiovascular Pharmacology and Therapeutics · Published 2026-03-01 · DOI 10.1177/10742484261431652
Background In patients with heart failure (HF), loop diuretics (LD) are recommended to relieve congestion and may be de-escalated if symptoms improve. However, long-term use of the same LD dose is sometimes required owing to potential congestion exacerbation. Therefore, we investigated the factors associated with LD de-escalation in patients with acute decompensated HF (ADHF) and the relationship between this de-escalation and initiating guideline directed medical therapy (GDMT) during hospitalization. Methods In this retrospective cohort study, patients with ADHF who were prescribed LD and GDMT at discharge were included. The primary endpoint was LD de-escalation at 6 months post-discharge. Factors associated with this de-escalation were extracted using multivariate analysis. The Cochran–Armitage trend test was used to analyze the relationship between the number of GDMT initiated during hospitalization and LD de-escalation. Results Of 193 eligible patients, 40.4% underwent LD de-escalation. Significant de-escalation-associated factors were age <75 years (odds ratio, 2.114; 95% confidence interval, 1.125-3.972), body mass index (BMI) ≥ 22.0 kg/m 2 (2.022; 1.073-3.811), and no atrial fibrillation (1.948; 1.047-3.625). The LD de-escalation rate tended to increase with the number of angiotensin receptor-neprilysin inhibitor, mineralocorticoid receptor antagonists, and sodium-glucose transporter 2 inhibitors initiated during hospitalization ( P = .013). Conclusion Younger age, high BMI, and no atrial fibrillation were LD de-escalation-associated factors in patients with ADHF. LD de-escalation post-discharge may occur more frequently if the number of GDMT with diuretic effects was increased during hospitalization.
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