Posted on January 25, 2001 at 10:53 a.m.
BIRMINGHAM, AL — Some congestive heart failure patients have likened taking diuretics to being under house arrest, according to Ali Ahmed, M.D., associate professor of epidemiology and faculty member at UAB's (University of Alabama at Birmingham) Center for Aging. But Ahmed doesn't think patients should have to decide between taking their medicine and staying at home or skipping their medicine and going out; although he and his colleagues have seen patients doing exactly that in their clinics.
Some patients skip their medicine to avoid embarrassing urinary accidents in public — an unfortunate side-effect of diuretics. Urinary incontinence, a condition that includes poor bladder control and urinary leakage, can occur for up to five to six hours after taking a diuretic, especially among older patients. However, the majority of congestive heart failure patients take a diuretic to control fluid build-up, a prevalent symptom of heart failure.
That is why Ahmed is beginning a study to look at whether changing the time a patient takes his medication has any effect on the patient's quality of life. Diuretics are typically taken in the morning in the belief that the dose during the day will improve the patient's quality of life by improving heart failure symptoms. Similarly, an evening dose is avoided in the belief that it would be disruptive to sound sleep due to frequency and urgency of urination. However, Ahmed says it is apparent that the diuretic effect of a mid-afternoon dose would be worn off by bedtime. Also the frequent urination associated with the mid-afternoon dose would occur in the evening when many older patients are home. The study also aims to make sure that a mid-afternoon dose improves quality of life without compromising heart failure status.
The study, funded by the Hartford Foundation, will randomize 40 patients in two groups. Both groups will be given four week's worth of Lasix (furosemide), the most commonly used diuretic, and four week's worth of placebo. One group will take the Lasix in the morning and the placebo between 3 and 5 p.m. The second group will take the placebo in the morning and the Lasix in the afternoon. Patients will monitor their fluid intake and bladder activity by using a bladder diary on the last three days of the four-week period. After medical assessment, the two groups will switch medication and placebo times, and will again be asked to keep a diary during the last three days.
"The ultimate outcome of this study is to find a way to keep people on their medicines without them having to restrict their social activities or without having to perform them in fear or anxiety about having an accident," Ahmed said. "Those are pretty pricey alternatives and I just don’t think they are ones any of us should have to pay."
Study participants must be ambulatory heart failure patients at least 65 who are on a single daily dose of 40 mg or more of furosemide and who have experienced at least one episode of urine leakage in the past. Participants will receive some compensation. For more information about the study, call Beth Deerman at (205) 934-2186.