Author + information
- Received May 14, 2020
- Revision received June 5, 2020
- Accepted June 8, 2020
- Published online August 3, 2020.
- Charles Faselis, MDa,b,c,∗∗ (, )@CharlesFaselis,
- Cherinne Arundel, MDa,b,d,
- Samir Patel, MDa,b,
- Phillip H. Lam, MDa,d,e@PhilLamMD,
- Stephen S. Gottlieb, MDf,g,
- Michael R. Zile, MDh,i,
- Prakash Deedwania, MDa,j,
- Gerasimos Filippatos, MDk,
- Helen M. Sheriff, MDa,b,
- Qing Zeng, PhDa,b,
- Charity J. Morgan, PhDa,l,
- Samuel Wopperer, MDa,d,e,
- Tran Nguyen, MDa,b,
- Richard M. Allman, MDb,m,
- Gregg C. Fonarow, MDn and
- Ali Ahmed, MD, MPHa,b,d,∗ (, )@DCVAMC@gcfmd@aamdmph
- aDepartment of Medicine, Veterans Affairs Medical Center, Washington, DC
- bDepartment of Medicine, George Washington University, Washington, DC
- cDepartment of Medicine, Uniformed Services University, Washington, DC
- dDepartment of Medicine, Georgetown University, Washington, DC
- eDepartment of Medicine, MedStar Washington Hospital Center, Washington, DC
- fDivision of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- gSection of Cardiology, Department of Medicine, Veterans Affairs Medical Center, Baltimore, Maryland
- hDivision of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
- iSection of Cardiology, Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
- jDivision of Cardiology, Department of Medicine, University of California, San Francisco, California
- kDivision of Cardiology, Department of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- lDepartment of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
- mDepartment of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- nDivision of Cardiology, Department of Medicine, University of California, Los Angeles, California
Background Heart failure (HF) is a major source of morbidity and mortality. Fluid retention and shortness of breath are its cardinal manifestations for which loop diuretics are used. Although their usefulness is well accepted, less is known about their role in improving clinical outcomes.
Objectives The purpose of this study was to determine the relationship between loop diuretics and clinical outcomes in patients with HF.
Methods Of the 25,345 older patients hospitalized for HF in the Medicare-linked OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) registry, 9,866 (39%) received no pre-admission diuretics. The study excluded 1,083 patients receiving dialysis and 847 discharged on thiazide diuretics. Of the remaining 7,936 patients, 5,568 (70%) were prescribed loop diuretics at discharge. Using propensity scores for receipt of loop diuretics estimated for each of the 7,936 patients, a matched cohort of 2,191 pairs of patients was assembled balanced on 74 baseline characteristics. Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes were estimated in the matched cohort.
Results Matched patients (n = 4,382) had a mean age of 78 years, 54% were women, and 11% were African American. The 30-day all-cause mortality occurred in 4.9% (107 of 2,191) and 6.6% (144 of 2,191) of patients in the loop diuretic and no loop diuretic groups, respectively (HR when the use of loop diuretics was compared with nonuse: 0.73; 95% CI: 0.57 to 0.94; p = 0.016). Patients in the loop diuretic group had a significantly lower risk of 30-day HF readmission (HR: 0.79; 95% CI: 0.63 to 0.99; p = 0.037) but not of 30-day all-cause readmission (HR: 0.89; 95% CI: 0.79 to 1.01; p = 0.081). None of the associations was statistically significant during 60 days of follow-up.
Conclusions Hospitalized older patients not taking diuretics prior to hospitalization for HF decompensation who received a discharge prescription for loop diuretics had significantly better 30-day clinical outcomes than those not discharged on loop diuretics. These findings provide new information about short-term clinical benefits associated with loop diuretic use in HF.
Dr. Ahmed has been supported in part by grants from the National Heart, Lung, and Blood Institute (NHLBI) (R01-HL085561, R01-HL085561-S, and R01-HL097047) and the Department of Veterans Affairs Office of Research and Development (IIR 17-095). OPTIMIZE-HF was sponsored by GlaxoSmithKline, but played no role in the design, conduct, analyses or interpretation of the current study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Department of Veterans Affairs. Dr. Fonarow has served as a consultant for Abbott, Amgen, AstraZeneca, Bayer, CHF Solutions, Janssen, Medtronic, Merck, and Novartis; and has served as the Principal Investigator of OPTIMIZE-HF. Dr Filippatos has participated in committees of trials and registries sponsored by Medtronic, Vifor, Boehringer Ingelheim, and Servier; and has received research grants from the European Union. All other authors have reported that they have no relationships relevant to the contents of this paper disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received May 14, 2020.
- Revision received June 5, 2020.
- Accepted June 8, 2020.
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