Heart failure, chronic diuretic use, and increase in mortality and hospitalization: an observational study using propensity score methods.
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.
Ahmed
Ali
A
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
Husain
Ahsan
A
Love
Thomas E
TE
Gambassi
Giovanni
G
Dell'Italia
Louis J
LJ
Francis
Gary S
GS
Gheorghiade
Mihai
M
Allman
Richard M
RM
Meleth
Sreelatha
S
Bourge
Robert C
RC
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
D002316:Cardiotonic Agents; D004232:Diuretics; D004077:Digoxin