The Year in Cardiology

Heart Failure: the Year in Cardiology 2019

John G.F. Cleland; Alexander R. Lyon; Theresa McDonagh; John J.V. McMurray


Eur Heart J. 2020;41(12):1232-1248. 

In This Article

Withdrawing Treatment for Heart Failure After Recovery

Withdrawing treatment from patients with idiopathic or genetically determined dilated cardiomyopathy who have experienced full recovery of ventricular function should be done with great caution if at all.[151] Although patients with a recovered LVEF (HFrcEF) may have a better prognosis, it may still not be good.[152] Further research is required for peripartum and other specific types of cardiomyopathy. A recent report from an old trial (DIG), suggested that withdrawal of digoxin was associated with an increased risk of hospitalization for heart failure but did not affect mortality.[153] An RCT of 188 patients with stable heart failure from Brazil suggested that 75% of patients could be withdrawn from loop diuretics for at least 90 days without deterioration in symptoms, need for reinstitution of diuretic therapy, or a rise in plasma NT-proBNP.[154] This is in stark contrast to a smaller RCT from the UK, where withdrawal of diuretics and other therapies for 48 h led to a doubling of plasma concentrations of NT-proBNP, an increase in LV and left atrial volumes and worsening symptoms.[155]