Prevalence and outcome of diuretic resistance in heart failure

  • Joan-Carles TrullàsEmail author
  • Jesús Casado
  • Jose-Luís Morales-Rull
  • Francesc Formiga
  • Alicia Conde-Martel
  • Raúl Quirós
  • Francisco Epelde
  • Álvaro González-Franco
  • Luis Manzano
  • Manuel Montero-Pérez-Barquero


Diuretic resistance (DR) is common in patients with decompensated heart failure (HF), and is associated with adverse outcomes. To determine the prevalence of DR and its impact on survival among patients with decompensated HF, we prospectively evaluated the prevalence and influence on prognosis of DR (defined as persistent congestion despite ≥ 80 mg of furosemide per day) in a cohort of elderly patients from the Spanish HF registry (RICA) admitted for an acute decompensation of HF. Patients with new-onset HF were excluded. From the global cohort of 2067 patients, 435 (21%; 95% CI 19.3%–22.7%) patients met criteria for DR. Patients with DR had more comorbidities (hypercholesterolemia, diabetes mellitus, valvular disease, chronic kidney disease, and cancer) and a worse functional status compared to patients without DR. In addition, patients with DR had a higher proportion of ischemic etiology, more advanced functional class and lower left ventricular ejection fraction values. After 1 year of follow-up, all-cause mortality was higher in patients with DR with an adjusted hazard ratio of 1.37 (95% CI 1.06–1.79; p = 0.018). The prevalence of DR in a cohort of elderly patients admitted for acute HF decompensation is 21%. DR is an independent predictor of 1-year mortality.


Heart failure Diuretics Furosemide 



we gratefully acknowledge all investigators who form part of the RICA Registry. This project was possible thanks to an educational unrestricted scholarship granted by Boehringer Ingelheim. We would like to thank RICA’s Registry Coordinating Center “S&H Medical Science Service” for their quality control data, logistic support, and administrative work and Prof. Salvador Ortiz, Universidad Autónoma de Madrid and Statistical Advisor S&H Medical Science Service, for the statistical analysis of the data presented in this paper.


This work was supported by an educational unrestricted scholarship granted by Boehringer Ingelheim.

Compliance with ethical standards

Conflict of interest

The authors declare that have no conflicts of interest.

Statements on human and animal rights

The registry complies with the Declaration of Helsinki. The local ethics committee from the University Hospital “Reina Sofia” (Córdoba, Spain) approved the study protocols.

Informed consent

Informed consent was obtained from all participating subjects.


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Copyright information

© Società Italiana di Medicina Interna (SIMI) 2019

Authors and Affiliations

  • Joan-Carles Trullàs
    • 1
    • 2
    Email author return OK on get
  • Jesús Casado
    • 3
  • Jose-Luís Morales-Rull
    • 4
  • Francesc Formiga
    • 5
  • Alicia Conde-Martel
    • 6
  • Raúl Quirós
    • 7
  • Francisco Epelde
    • 8
  • Álvaro González-Franco
    • 9
  • Luis Manzano
    • 10
  • Manuel Montero-Pérez-Barquero
    • 11
  1. 1.Internal Medicine Service, Hospital de OlotOlot, GironaSpain
  2. 2.Medical Sciences DepartmentUniversitat de GironaGironaSpain
  3. 3.Internal Medicine ServiceHospital Universitario de GetafeMadridSpain
  4. 4.Internal Medicine ServiceHospital Universitario “Arnau de Vilanova”LleidaSpain
  5. 5.Internal Medicine ServiceHospital Universitari de Bellvitge, L’Hospitalet de LlobregatBarcelonaSpain
  6. 6.Internal Medicine ServiceHospital Universitario de Gran Canaria Dr. NegrínLas PalmasSpain
  7. 7.Internal Medicine ServiceHospital Costa del SolMálagaSpain
  8. 8.Internal Medicine ServiceCorporaciò Sanitaria Parc TaulíBarcelonaSpain
  9. 9.Internal Medicine ServiceHospital Universitario Central de AsturiasAsturiasSpain
  10. 10.Internal Medicine ServiceHospital Universitario Ramón y Cajal, Universidad de Alcalá (IRYCIS)MadridSpain
  11. 11.Internal Medicine ServiceIMIBIC/Hospital Reina Sofía, Universidad de CórdobaCórdobaSpain

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