Journal
EUROPEAN HEART JOURNAL
Volume 27, Issue 12, Pages 1431-1439Publisher
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehi890
Keywords
heart failure; diuretics; mortality; hospitalization; propensity scores
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Funding
- NHLBI NIH HHS [P50HL077100, P50 HL077100] Funding Source: Medline
- NIA NIH HHS [K23 AG019211-01A2, K23 AG019211-02, K23 AG019211, 1-K23-AG19211-01, K23 AG019211-03] Funding Source: Medline
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Aims Non-potassium-sparing diuretics are commonly used in heart failure (NF). They activate the neurohormonal system, and are potentially harmful. Yet, the long-term effects of chronic diuretic use in HF are largely unknown. We retrospectively analysed the Digitalis Investigation Group (DIG) data to determine the effects of diuretics on HF outcomes. Methods and results Propensity scores for diuretic use were calculated for each of the 7788 DIG participants using a non-parsimonious multivariable logistic regression model, and were used to match 1391 (81%) no-diuretic patients with 1391 diuretic patients. Effects of diuretics on mortality and hospitalization at 40 months of median follow-up were assessed using matched Cox regression models. All-cause mortality was 21% for no-diuretic patients and 29% for diuretic patients [hazard ratio (HR) 1.31; 95% confidence interval (CI) 1.11-1.55; P=0.002]. HF hospitalizations occurred in 18% of no-diuretic patients and 23% of diuretic patients (HR 1.37; 95% CI 1.13-1.65; P=0.001). Conclusion Chronic diuretic use was associated with increased long-term mortality and hospitalizations in a wide spectrum of ambulatory chronic systolic and diastolic HF patients. The findings of the current study challenge the wisdom of routine chronic use of diuretics in HF patients who are asymptomatic or minimally symptomatic without fluid retention, and are on complete neurohormonal blockade. These findings, based on a non-randomized design, need to be further studied in randomized trials.
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