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Background: Furosemide is a loop diuretic that may cause a loss of bone mineral density, and thus an increased incidence of bone fractures. Congenital heart disease (CHD) patients are often placed on furosemide. The purpose was to determine the association of furosemide therapy with the incidence of bone fractures in pediatric CHD patients.
Methods: Data were extracted from Texas Medicaid databases. Pediatric patients aged < 12 years diagnosed with CHD, cardiomyopathy, or heart failure (2008 – 2014; median follow-up 3 years) were included. Patients taking furosemide were categorized into two groups: (1) Furosemide-Adherent group (Medication Possession Ratio (MPR) ≥ 70%), and (2) Furosemide Non-adherent group (MPR < 70%). A third group of patients was matched to the furosemide user groups by employing propensity score matching. A multivariate logistic regression and Cox proportional hazard model with a Kaplan-Meier plot (time-to-fracture) were used to compare the three groups, controlling for baseline demographics and clinical characteristics.
Results: After matching, 3,912 patients (Furosemide-Adherent: 254, Furosemide Non-Adherent: 724, No Furosemide: 2,934) were identified. The incidence of fractures was highest for the furosemide-adherent group (9.06%; 23/254), followed by the Furosemide Non-Adherent group (7.18%; 52/724), which were both higher than for patients who did not receive furosemide (5.04%; 148/2,934) (p <0.001). Using logistic regression, (reference group = no furosemide) both furosemide groups were more likely to have fractures compared to the reference; Furosemide-Adherent OR=1.87 (95% CI: 1.17 −2.98), p=0.009; Furosemide-Non-Adherent OR=1.53 (95% CI: 1.10-2.14), p=0.011. In the Cox proportional hazard model, the risk of fractures for the furosemide-adherent group was significantly higher compared to the no furosemide group (HR=1.56; 95% CI: 1.01-2.42), p=0.049.
Conclusions: Our results indicated that furosemide therapy in children with CHD was associated with an increased risk of bone fractures. Clinicians who treat patients with heart disease should be aware of the increased risk of fractures and screen for bone disease in this patient population.
Moderated Poster Contributions
Congenital Heart Disease and Pulmonary Hypertension Moderated Poster Theater, Poster Hall, Hall C
Saturday, March 18, 2017, 1:00 p.m.-1:10 p.m.
Session Title: Therapeutic Advances in Congenital Heart Disease
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 1220M-07
- 2017 American College of Cardiology Foundation