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. 2006 Jun;27(12):1431-9.
doi: 10.1093/eurheartj/ehi890. Epub 2006 May 18.

Heart failure, chronic diuretic use, and increase in mortality and hospitalization: an observational study using propensity score methods

Ali Ahmed  1 , Ahsan Husain, Thomas E Love, Giovanni Gambassi, Louis J Dell'Italia, Gary S Francis, Mihai Gheorghiade, Richard M Allman, Sreelatha Meleth, Robert C Bourge
Affiliations

Heart failure, chronic diuretic use, and increase in mortality and hospitalization: an observational study using propensity score methods

Ali Ahmed et al. Eur Heart J. 2006 Jun.

Abstract

Aims: 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.

Methods and 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).

Conclusion: 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.

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Figures

Figure 1
Figure 1
Absolute standardized differences before and after propensity score matching comparing covariate values for patients receiving and not receiving diuretics.
Figure 2
Figure 2
Kaplan–Meier plots for cumulative risk of mortality due to (A)all causes and (B) worsening heart failure.
Figure 3
Figure 3
Kaplan–Meier plots for cumulative risk of hospitalizations due to (A) all causes and (B) worsening heart failure.
Figure 4
Figure 4
Hazard ratios (95% CI) for all-cause mortality in subgroups of patients with heart failure (ACE-inhibitor, angiotensin-converting enzyme-inhibitor).
See this image and copyright information in PMC

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