Clinical findings and survival time in dogs with advanced heart failure

Background Dogs with advanced heart failure are a clinical challenge for veterinarians but there are no studies reporting clinical features and outcome of this population. Hypothesis/Objectives To describe clinical findings and outcome of dogs with advanced heart failure caused by degenerative mitral valve disease (DMVD). Animals Fifty‐four dogs with advanced heart failure because of DMVD. Methods For study purposes, advanced heart failure was defined as recurrence of congestive heart failure signs despite receiving the initially prescribed dose of pimobendan, angiotensin‐converting‐enzyme inhibitor (ACEI), and furosemide >4 mg/kg/day. Data were collected for the time of diagnosis of Stage C heart failure and time of diagnosis of advanced heart failure. Date of death was recorded. Results At the diagnosis of advanced heart failure, doses of pimobendan (n = 30), furosemide (n = 28), ACEI (n = 13), and spironolactone (n = 4) were increased, with ≥1 new medications added in most dogs. After initial diagnosis of advanced heart failure, 38 (70%) dogs had additional medications adjustments (median = 2 [range, 0‐27]), with the final total medication number ranging from 2‐10 (median = 5). Median survival time after diagnosis of advanced heart failure was 281 days (range, 3‐885 days). Dogs receiving a furosemide dose >6.70 mg/kg/day had significantly longer median survival times (402 days [range, 3‐885 days] versus 129 days [range 9‐853 days]; P  = .017). Conclusions and Clinical Importance Dogs with advanced heart failure can have relatively long survival times. Higher furosemide dose and non‐hospitalization were associated with longer survival.