In patients hospitalized for heart failure (HF), losing at least 2 kg of weight while receiving treatment with intravenous loop diuretic may be a good prognostic signal, being associated with reduced 30-day risk of HF rehospitalization regardless of renal function status, as shown in a study.
In the nationwide Swedish Heart Failure Registry cohort of 4,979 patients (median age 80 years, 57 percent male) who received intravenous loop diuretics during HF hospitalization and survived to discharge, 59 percent achieved weight loss, defined as a 2-kg reduction in body weight between admission and discharge. The median weight change during hospitalization was −2.5 kg. [Heart 2026;doi:10.1136/heartjnl-2026-328175]
Patients who achieved weight loss were more likely to be male, have obesity, hyperkalaemia, atrial fibrillation, elevated N-terminal pro-B-type natriuretic peptides (NT-proBNP) levels, anaemia, and tachycardia. They were also more likely to receive mineralocorticoid receptor antagonists and oral loop diuretics at discharge.
Weight loss was associated with a 41-percent reduced risk of the primary outcome of HF rehospitalization (hazard ratio [HR], 0.59, 95 percent confidence interval [CI], 0.53–0.67; p<0.001) and 24-percent reduced risk of the secondary composite outcome of cardiovascular death or HF rehospitalization (HR, 0.76, 95 percent CI, 0.69–0.84; p<0.001) at 30 days.
Diuretic-induced weight loss was consistently associated with lower 30-day risks of the primary and secondary outcomes regardless of in-hospital changes in haemoglobin, estimated glomerular filtration rate (eGFR), NT-proBNP, potassium, and sodium.
Principal investigator Dr Mikael Erhardsson from the Karolinska Institute, Stockholm, Sweden, and colleagues highlighted the clinical implication of the finding showing no significant correlation between weight loss and changes in biomarkers, especially eGFR.
“A deteriorating renal function is what makes physicians cautious, resulting in less effective diuresis. We show that it appears feasible to achieve decongestion as assessed by weight loss regardless of worsening, an important finding suggesting more attention should be paid to get the patient decongested to reduce the risk of HF rehospitalization,” Edhardsson and colleagues noted.
The takeaway, they said, is that weight loss can be used as a pragmatic marker of successful decongestion and that concerns about worsening renal function alone should not necessarily discourage effective decongestive therapy.
However, Edhardsson and colleagues noted that the association between weight loss and favourable outcomes did not persist beyond 30 days.
“The lack of effect during a longer duration is likely multifactorial, and other causes of death than cardiovascular disease-related are likely during follow-up. Furthermore, intravenous diuretic use during HF hospitalization is a short-term intervention, and maintaining normovolaemia in the long term depends on up-titration of HF therapies and adequate use of diuretics post-discharge,” they pointed out.
The study had several limitations, including the observational nature of the study. Weight loss during HF hospitalization was assumed to reflect intravenous loop diuretic use, and the effects of reduced food intake and other diuretics could not be assessed due to unavailable data. Additionally, there were no data on the doses of intravenous loop diuretics doses in the cohort.