title: Heart failure, chronic diuretic use, and increase in mortality and hospitalization: an observational study using propensity score methods.
abstract: OBJECTIVE
  Non-potassium-sparing diuretics are commonly used in heart failure (HF). 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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, School of Medicine, and Department of Epidemiology, School of Public Health, and Center for Heart Failure Research, University of Alabama at Birmingham and VA Medical Center, 35294-2041, USA. aahmed@uab.edu
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
authors.forename: Ahsan
authors.initials: A
authors.lastname: Husain
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Love
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gambassi
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Dell'Italia
authors.forename: Gary S
authors.initials: GS
authors.lastname: Francis
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.forename: Richard M
authors.initials: RM
authors.lastname: Allman
authors.forename: Sreelatha
authors.initials: S
authors.lastname: Meleth
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bourge
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002908:Chronic Disease; D004077:Digoxin / Q000627:therapeutic use; D004232:Diuretics / Q000009:adverse effects*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies
chemical_list: D002316:Cardiotonic Agents; D004232:Diuretics; D004077:Digoxin