Cardiology · 2 h ago
High-dose IV loop diuretics were not linked to permanent hearing loss in heart failure cohorts
A three-cohort study assessed hearing changes during high-dose intravenous loop diuretic treatment in patients with heart failure. Temporary hearing shifts occurred more often around peak drug concentration in a small outpatient cohort, but were largely resolved within hours; hospitalized cohort data did not show a dose association.
- Temporary hearing shifts were uncommon and mostly resolved within hours.
- Higher doses correlated with shifts only at peak concentration in one cohort.
- Hospitalization data showed no significant dose-related ototoxicity risk.
- Repeated exposure and concomitant ototoxins were not assessed.
This study examined intravenous loop diuretic (LD) exposure and ototoxicity across three cohorts: 50 outpatients with stable heart failure who received randomized bumetanide doses, 40 hospitalized patients with acute heart failure who underwent serial audiometry during treatment, and a multicenter retrospective cohort of 22,656 heart-failure hospitalizations assessed using diagnostic codes. The primary outcomes were audiometric hearing changes and clinically diagnosed ototoxicity.
In the outpatient cohort, hearing shifts at peak diuretic concentration occurred in 24 of 400 dose assessments (6%) and were more frequent with higher doses (odds ratio, 1.99 per dose doubling; 95% CI, 1.21-3.28). Shifts largely resolved within hours and were absent in 393 of 400 measurements. In the hospitalized audiometry cohort, hearing changes were not associated with LD dose. Clinically diagnosed ototoxicity was recorded in 608 hospitalizations (2.7%); higher peak dose categories were not significantly associated with greater risk.
The findings do not indicate permanent ototoxicity associated with short-term high-dose LD exposure in these cohorts. However, the audiometry cohorts were small, concomitant ototoxin use was excluded, and the authors call for research on repeated exposure and broader heart-failure populations.
In practice
For patients with heart failure receiving short-term intravenous loop diuretics, these data do not show an association between higher doses and permanent or clinically diagnosed ototoxicity. A small outpatient cohort did show more transient audiometric shifts at peak drug concentration, but these largely resolved within hours; a hospitalized audiometry cohort showed no dose association. The evidence does not establish safety with repeated exposure or in patients receiving concomitant ototoxic drugs, which were excluded, and should not be generalized beyond the studied populations.
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JAMA Cardiology: Assessment of Ototoxicity in Patients With Heart Failure Receiving High-Dose IV Loop Diuretics ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.