REDICAE: Diuretics withdrawal appears feasible in stable HFrEF

Withdrawal of diuretics appeared to be feasible in stable, euvolemic outpatients with heart failure with reduced ejection fraction (HFrEF) on guideline-directed medical therapy. There was no increase in perceived dyspnoea or the incidence of HF decompensation in patients who withdrew from diuretics compared with those who kept using diuretics.

The phase 2 REDICAE trial (NCT05964738) randomised 98 stable and euvolemic outpatients with HFrEF 1:1 to diuretic withdrawal or maintenance [1]. The primary endpoint was perceived dyspnoea at 24 weeks, as was assessed by a visual analogue scale.

At 24 weeks, there was no difference in perceived dyspnoea between participants in the withdrawal arm and those in the control arm (least-square mean difference 2 mm; 95% CI -1.8 to +4.9; P=0.37). Similarly, there was no association between diuretic withdrawal and worsening HF events. “We also did not see any differences with respect to congestion parameters, such as NT-proBNP, between both arms of the study,” added Dr Jesus Torres Zamudio (Reina Sofia University Hospital Cordoba, Spain).

Discontinuation of diuretics in stable euvolemic outpatients with HFrEF on guideline-directed medical therapy did not lead to increased perceived dyspnoea or a higher incidence of HF events. Moreover, there was no association between diuretic withdrawal and quality-of-life or exercise capacity. “The sample size of this study was rather small compared with other HF trials,” Dr Torres Zamudio addressed the limitations of the REDICAE trial. “Also, a non-inferiority design may have been more appropriate given the study’s research question.”

1. Torres Zamudio JA, et al. Safety and tolerability of diuretics withdrawal in patients with heart failure with reduced ejection fraction: REDICAE trial. Late-breaking clinical trials in chronic heart failure, Heart Failure 2025, 17–20 May, Belgrade, Serbia.

Medical writing support was provided by Robert van den Heuvel.
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Posted on 22 May 2025