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Comparative Study
. 2008 Apr 10;125(2):246-53.
doi: 10.1016/j.ijcard.2007.05.032. Epub 2007 Aug 16.

A propensity-matched study of the effects of chronic diuretic therapy on mortality and hospitalization in older adults with heart failure

Ali Ahmed  1 , James B Young, Thomas E Love, Raynald Levesque, Betram Pitt
Affiliations
Comparative Study

A propensity-matched study of the effects of chronic diuretic therapy on mortality and hospitalization in older adults with heart failure

Ali Ahmed et al. Int J Cardiol. .

Abstract

Background: Non-potassium-sparing diuretics may increase mortality and hospitalizations in heart failure patients. Most heart failure patients are older adults, yet the effect of diuretics on cause-specific mortality and hospitalizations in older adults with heart failure is unknown. The objective of this propensity-matched study was to determine the effect of diuretics on mortality and hospitalizations in heart failure patients >or=65 years.

Methods: Of the 7788 Digitalis Investigation Group participants, 4036 were >or=65 years and 3271 (81%) were receiving diuretics. Propensity scores for diuretic use for each of the 4036 patients were calculated using a non-parsimonious multivariable logistic regression model incorporating all measured baseline covariates, and were used to match 651 (85%) patients not receiving diuretics with 651 patients receiving diuretics. Effects of diuretics on mortality and hospitalization at 37 months of median follow-up were assessed using matched Cox regression models.

Results: All-cause mortality occurred in 173 patients not receiving diuretics and 208 patients receiving diuretics respectively during 2056 and 1943 person-years of follow-up (hazard ratio {HR}=1.36; 95% confidence interval {CI}=1.08-1.71; p=0.009). All-cause hospitalizations occurred in 413 patients not receiving and 438 patients receiving diuretics respectively during 1255 and 1144 person-years of follow-up (HR=1.18; 95% CI=0.99-1.39; p=0.063). Diuretic use was associated with significant increased risk of cardiovascular mortality (HR=1.50; 95% CI=1.15-1.96; p=0.003).and heart failure hospitalization (HR=1.48; 95% CI=1.13-1.94; p=0.005).

Conclusions: Chronic diuretic use was associated with significant increased mortality and hospitalization in ambulatory older adults with heart failure receiving angiotensin converting enzyme inhibitor and diuretics.

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Conflict of interest statement

Conflict of Interest Disclosures: None

Figures

Figure 1
Figure 1
Distribution of propensity score for the receipt of diuretic (a) before, and (b) after matching, and among (c) unmatched patients
Figure 2
Figure 2
Absolute standardized differences in covariates between patients receiving and not receiving diuretic, before and after propensity score matching
Figure 3
Figure 3
Kaplan-Meier plots for (a) all-cause mortality, (b) all-cause hospitalizations, and (c) heart failure hospitalization
See this image and copyright information in PMC

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