Prescription patterns of diuretics in chronic heart failure: a contemporary background as a clue to their role in treatment.
BACKGROUND
Diuretics are the cornerstone of treatment for the congestive symptoms of heart failure (HF). Despite their widespread use, diuretic prescription data in clinical practice are scarce. In this study we evaluated the prescription pattern of diuretics in a large population of HF outpatients, enrolled by a national network of hospital-based cardiologists.


RESULTS
Among 11070 HF outpatients (mean age 64 +/- 12 years, 72.9% men, 29.8% New York Heart Association [NYHA] class III-IV, mean left ventricular ejection fraction [LVEF] 35+/-12%), 9247 took a diuretic, the most frequently prescribed therapeutic agent (83.5%). Loop diuretics were prescribed alone (65.5%) or combined with other diuretics in 91.6% of patients. By multivariate analysis, the strongest independent predictors of diuretic use were a previous hospital admission for HF (odds ratio [OR] 2.55, 95% confidence interval [CI] 2.28-2.86), NYHA class III-IV (OR 2.52, 95% CI 2.14-2.96), LVEF < 30% (OR 1.87, 95% CI 1.57-2.24). Aldosterone antagonists were prescribed to 2142 patients (23.1%); independent predictors of their use overlapped with those of diuretics and moreover included treatment with loop diuretics (OR 3.52, 95% CI 2.66-4.66) and digoxin (OR 1.45, 95% CI 1.29-1.64).


CONCLUSIONS
In this wide series of stable HF outpatients, cardiologists prescribed diuretics in accordance with published guidelines. Evolving prescription patterns of aldosterone-receptor blockers need to be further evaluated.
Faggiano
Pompilio
P
Department of Cardiology, Brescia, Italy.
Opasich
Cristina
C
Tavazzi
Luigi
L
Achilli
Felice
F
Gentile
Anna
A
De Biase
Luciano
L
De Maria
Renata
R
Pozzi
Roberto
R
Tarantini
Luigi
L
Gonzini
Lucio
L
Maggioni
Aldo P
AP
D004232:Diuretics / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data
D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists