Loop diuretics (LD) remain a key therapy for relieving congestion in patients with heart failure (HF). Although doses may be reduced when symptoms stabilize, some individuals require continued therapy at the same dose because congestion may recur. A retrospective cohort analysis published in the Journal of Cardiovascular Pharmacology and Therapeutics examined clinical factors associated with LD dose de-escalation following hospitalization for acute decompensated heart failure (ADHF) and evaluated whether the number of guideline-directed medical therapy (GDMT) agents initiated during hospitalization was related to subsequent LD dose reduction.

The study included patients hospitalized with ADHF who were discharged on both LD and GDMT. The primary endpoint was the reduction of the LD dose within 6 months after discharge. Multivariate analysis identified factors associated with LD de-escalation, and the Cochran–Armitage trend test assessed whether the number of GDMT agents initiated during hospitalization was related to the likelihood of LD dose reduction.

Among 193 eligible patients, LD dose de-escalation was observed in 40.4% at 6 months after discharge. Factors associated with dose reduction included age <75 years (odds ratio [OR] 2.114; 95% confidence interval [CI] 1.125–3.972), body mass index ≥22.0 kg/m² (OR 2.022; 95% CI 1.073–3.811), and absence of atrial fibrillation (OR 1.948; 95% CI 1.047–3.625). Higher rates of LD de-escalation were observed as the number of GDMT agents initiated during hospitalization increased, including angiotensin receptor–neprilysin inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose transporter 2 inhibitors (trend P = 0.013).

These findings indicate that younger age, higher body mass index, and absence of atrial fibrillation were associated with loop diuretic dose reduction after ADHF hospitalization. De-escalation of LD therapy occurred more frequently when a greater number of GDMT agents with diuretic effects were initiated during hospitalization.