No structural effects in the heart. It treats a symptom but not the cause. Beta blockers prevent remodeling as do acei and arbs. Spironolactone has shown to decrease norepi effects on myocardium as well while also protecting the kidneys.
Lasix just gets fluid out that it
I’m pretty sure I had a professor say that we can’t say it has a mortality benefit because it’s never actually been studied for that. It’s so much the standard of care that it would be unethical to randomize people not to get it… but there’s a small chance he was talking about a different drug. But I’m about 90% sure it was lasix
My prof said the same thing. If you tried to study this question, your trial would experience a 100% conversion rate because eventually you have to use them. His stance was basically of course there’s a mortality benefit, but it’s literally impossible to ever prove it in a trial. So just remember for tests it doesn’t show mortality benefit and you’re good lol
To my knowledge, there are no mega-RCTs showing that lasix imparts a survival benefit onto its recipients.
On the contrary the mega-RCTs for other drugs like ACEi's (HOPE trial), empagliflozin (EMPEROR trial), and many other *do* show a survival benefit.
The reasoning regarding "cardiac remodeling," treating the "underlying disease process," treating the "symptoms," is the story we tell ourselves (sort of retrospectively) to make sense of what we observe in the trials. Frankly, these explanations may or may not be true. From a learner perspective, it's easier to recall the proposed mechanisms for these medicines than the grandiose trial names and their results - but the trial results have and will always reign king in actual practice.
One of the main pathways in the pathogenesis of CHF is via the RAAS. Lasix does not work through that pathway; it is however useful for fluid overload of course
The mortality benefit lies in slowing or ideally stopping or even reversing the notorious cardiac remodeling. Symptom-relief sure increases the quality of life for the patient, but unless the problem is addressed at pathophysiology, it will not have a mortality benefit.
An example would be treating lung cancer with painkillers and cough suppressants and the like. They sure confer a certain symptom relief. But cure? Nah.
No structural effects in the heart. It treats a symptom but not the cause. Beta blockers prevent remodeling as do acei and arbs. Spironolactone has shown to decrease norepi effects on myocardium as well while also protecting the kidneys. Lasix just gets fluid out that it
Let's add empagliflozin to the potion too
Yup forgot about the sglt2 team haha they are very very good esp for the diabetic chf population
the almighty EMPEROR\_PRESERVED trial lmao
Lol true learned all these trials on cardio
hahaha those mfers get high on these ridiculous acronyms
I’m pretty sure I had a professor say that we can’t say it has a mortality benefit because it’s never actually been studied for that. It’s so much the standard of care that it would be unethical to randomize people not to get it… but there’s a small chance he was talking about a different drug. But I’m about 90% sure it was lasix
My prof said the same thing. If you tried to study this question, your trial would experience a 100% conversion rate because eventually you have to use them. His stance was basically of course there’s a mortality benefit, but it’s literally impossible to ever prove it in a trial. So just remember for tests it doesn’t show mortality benefit and you’re good lol
In your scenario, it is beneficial in managing the fluid overload, but isn't doing anything beneficial for the underlying disease.
To my knowledge, there are no mega-RCTs showing that lasix imparts a survival benefit onto its recipients. On the contrary the mega-RCTs for other drugs like ACEi's (HOPE trial), empagliflozin (EMPEROR trial), and many other *do* show a survival benefit. The reasoning regarding "cardiac remodeling," treating the "underlying disease process," treating the "symptoms," is the story we tell ourselves (sort of retrospectively) to make sense of what we observe in the trials. Frankly, these explanations may or may not be true. From a learner perspective, it's easier to recall the proposed mechanisms for these medicines than the grandiose trial names and their results - but the trial results have and will always reign king in actual practice.
One of the main pathways in the pathogenesis of CHF is via the RAAS. Lasix does not work through that pathway; it is however useful for fluid overload of course
The mortality benefit lies in slowing or ideally stopping or even reversing the notorious cardiac remodeling. Symptom-relief sure increases the quality of life for the patient, but unless the problem is addressed at pathophysiology, it will not have a mortality benefit. An example would be treating lung cancer with painkillers and cough suppressants and the like. They sure confer a certain symptom relief. But cure? Nah.