Prolonged therapy by the combination of furosemide and thiazides in refractory heart failure and other fluid retaining conditions

The efficacy and side effects of the combination therapy of thiazide and furosemide administered to patients with refractory heart failure, for a prolonged period of time, were assessed. Thirty-two patients were hospitalized during the years 1985–1991. Left heart failure (left ventricular ejection fraction (LVEF = 22.4% ± 6.6%) was present in 26 patients, right heart failure in 3 patients, chronic renal failure, cirrhosis and bilateral pleural effusion were present each in one patient. Chlorothiazide 0.5 g daily was added to conventional therapy. Patients were monitored closely during hospitalization and later as outpatients. During hospitalization, addition of chlorothiazide caused a reduction of 4.8 ± 4.0 kg in patientsʹ weight, serum potassium decreased from 4.4 ± 0.6 to 4.0 ± 0.5 mmol/l (P < 0.005) and serum sodium from 139.0 ± 4.7 to 136.8 ± 5.5 mmol/l (P < 0.05). The duration of the combined therapy was 17.2 ± 19.1 months. Thirteen patients had short treatment (1.6 ± 0.8 months) and 19 patients had prolonged treatment (26.5 ± 19.0 months). No specific characteristics distinguished patients in both groups. Thiazides were discontinued in 19 patients, 10 of which had side effects. In only 5 of the 19 patients treated for the prolonged period had thiazides to be discontinued because of side effects. Addition of thiazides to furosemide is efficacious in severe heart failure. The combination should be started during hospitalization. Many patients can be maintained on this combination for a prolonged period of time on an ambulatory basis.