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Aims  Pharmacological therapies for heart failure ( HF ) aim to improve congestion, symptoms, and prognosis. Failing to take medication is a potential cause of worsening  HF . Characterizing the effects of short‐term medication omission could inform the development of better technologies and strategies to detect and interpret the reasons for worsening  HF . We examined the effect of planned  HF  medication omission for 48 h on weight, echocardiograms, transthoracic bio‐impedance, and plasma concentrations of  NT‐proBNP .    Methods and results  Outpatients with stable  HF  and an  LVEF  <45% were assigned to take or omit their  HF  medication for 48 h in a randomized, crossover trial. Twenty patients (16 men,  LVEF  32 ± 9%, median  NT‐proBNP  962 ng/L) were included. Compared with regular medication, omission led to an increase in  NT‐proBNP  by 99% (from 962 to 1883 ng/L,  P  < 0.001), systolic blood pressure by 16% (from 131 to 152  mmHg ,  P  < 0.001), and left atrial volume by 21% (from 69 to 80  mL ,  P  = 0.001), and reductions in transthoracic bio‐impedance by 10% (from 33 to 30 Σ,  P  = 0.001) and serum creatinine by 8% (from 135 to 118 µmol/L,  P  = 0.012). No significant changes in body weight, heart rate, or  LVEF  were observed.    Conclusions  The characteristic pattern of response to short‐term medication omission is of increasing congestion but, in contrast to the pattern reported for disease progression, with a rise in blood pressure and improved renal function. In stable  HF , weight is not a sensitive marker of short‐term diuretic omission.

The effects of short‐term omission of daily medication on the pathophysiology of heart failure