The daily challenges to patients posed by diuretic therapy: What they are and what do patients do?

Abstract

Diuretics play a central role in the management of patients with heart failure. In fact, they are used to achieve and maintain euvolaemia through adequate fluid balance. The effects, clinical benefits and implications of diuretic therapy are well established. However, little is known about the inconveniences posed to patients by diuretics and the adaptations adopted by them to counteract these challenges.

We conducted a study to investigate the patient impact of diuretic therapy.

A comprehensive questionnaire was formulated and distributed to patients with established heart failure (with reduced and preserved ejection fraction) attending a specialized heart failure service. Questionnaires were given to patients once they had been established on heart failure disease-modifying therapy and diuretic therapy for at least 3 months and had received self-care education including information on medication and adherence to drug regimens. Patients were established either on oral furosemide or bumetanide with doses ranging from 20 to 80 mg daily and 0.5 to 6 mg daily, respectively. The questionnaire encompassed information on inconvenience from the use of diuretics, what those manifestations were (if any) and what the patients did to overcome the inconvenience (if something was done). The patients also commented on whether they felt that the benefits were worth the inconvenience of the diuretics.

A sample of 150 patients was analysed; 53% of the patients (n = 79) reported experiencing inconvenience secondary to the use of diuretics. The most common ones were difficulty leaving the house (30%, n = 48), difficulty sleeping at night-time (17%, n = 32), feeling anxious (15%, n = 29), difficulty meeting friends and family (14%, n = 22), difficulty pursing their hobbies (13%, n = 19) and difficulty in their sexual life (11%, n = 16). Of the patients impacted by the use of diuretics, 87% (n = 69) acted in response to the inconveniences opting for staying at home (25%, n = 46), reducing their level of activities (25%, n = 46), altering the time of diuretics (19%, n = 35), fluid restriction (19%, n = 35), avoiding using diuretics (9%, n = 18) and contacting doctors or heart failure nurses (3%, n = 6). The remaining 10 patients who experienced inconvenience (13%) reported not seeking medical attention or applying any changes to their routine or therapy. Lastly, 58 patients (73%) who experienced inconveniences stated that the benefits resulting from the use of diuretics were worth their side effects (Table 1).

In this study on the inconvenience posed to patients by diuretic therapy, the data demonstrate that more than half of patients experience inconvenience. These difficulties and subsequent patient response present clinical and social risk to the patients with reduced activity and reduction/cessation of diuretic without medical consultation.

We believe that heightened awareness of these challenges among healthcare personnel posed by diuretics to patients is important in order to best advise on how to combat these difficulties. Further studies on whether specific types of diuretics may cause greater inconvenience for the patients would be warranted as well as follow-up to assess the incidence of iatrogenic decompensations in this cohort.