European Heart Journal Advance Access originally published online on May 18, 2006
European Heart Journal 2006 27(12):1431-1439; doi:10.1093/eurheartj/ehi890
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Heart failure, chronic diuretic use, and increase in mortality and hospitalization: an observational study using propensity score methods
1 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, 1530, 3rd Avenue South, CH-19, Ste-219, Birmingham, AL 35294-2041, USA
2 Departments of Physiology and Medicine, School of Medicine, and Center for Heart Failure Research, University of Alabama at Birmingham, Birmingham, AL, USA
3 Department of Medicine, School of Medicine and Department of Operations, Weatherhead School of Management, and Biostatistics and Evaluation Unit, Center for Health Care Research and Policy, Case Western Reserve University, Cleveland, OH, USA
4 Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Rome, Italy and Department of Community Health, Brown Medical School, Providence, RI, USA
5 Departments of Medicine and Physiology, School of Medicine, and Center for Heart Failure Research, University of Alabama at Birmingham and VA Medical Center, Birmingham, AL, USA
6 Department of Cardiovascular Medicine and Kaufman Center for Heart Failure, Cleveland Clinic Foundation, and Department of Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
7 Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
8 Department of Medicine, School of Medicine, University of Alabama at Birmingham, and Birmingham/Atlanta VA Geriatric Research, Education and Clinical Center, Birmingham, AL, USA
9 Department of Medicine, and Biostatistics and Bioinformatics Shared Facility, Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
10 Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
Received 7 November 2005; revised 25 March 2006; accepted 30 March 2006; online publish-ahead-of-print 18 May 2006.
* Corresponding author. Tel: +1 205 934 9632; fax: +1 205 975 7099. E-mail address: aahmed{at}uab.edu
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.
Key Words: Heart failure • Diuretics • Mortality • Hospitalization • Propensity scores
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  B. A. Bart Treatment of Congestion in Congestive Heart Failure: Ultrafiltration Is the Only Rational Initial Treatment of Volume Overload in Decompensated Heart Failure Circ Heart Fail, September 1, 2009; 2(5): 499 - 504. [Full Text] [PDF]
|
|
|
|
 |
|
 M. I. Ahmed, M. White, O. J. Ekundayo, T. E. Love, I. Aban, B. Liu, W. S. Aronow, and A. Ahmed A history of atrial fibrillation and outcomes in chronic advanced systolic heart failure: a propensity-matched study Eur. Heart J., August 2, 2009; 30(16): 2029 - 2037. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. J. Ekundayo, R. M. Allman, P. W. Sanders, I. Aban, T. E. Love, D. Arnett, and A. Ahmed Isolated Systolic Hypertension and Incident Heart Failure in Older Adults: A Propensity-Matched Study Hypertension, March 1, 2009; 53(3): 458 - 465. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. M. Felker, C. M. O'Connor, E. Braunwald, and for the Heart Failure Clinical Research Network In Loop Diuretics in Acute Decompensated Heart Failure: Necessary? Evil? A Necessary Evil? Circ Heart Fail, January 1, 2009; 2(1): 56 - 62. [Full Text] [PDF]
|
|
|
|
 |
|
 R. C. Campbell, X. Sui, G. Filippatos, T. E. Love, C. Wahle, P. W. Sanders, and A. Ahmed Association of chronic kidney disease with outcomes in chronic heart failure: a propensity-matched study Nephrol. Dial. Transplant., January 1, 2009; 24(1): 186 - 193. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. C. Austin Primer on Statistical Interpretation or Methods Report Card on Propensity-Score Matching in the Cardiology Literature From 2004 to 2006: A Systematic Review Circ Cardiovasc Qual Outcomes, September 1, 2008; 1(1): 62 - 67. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Pitt, A. Ahmed, T. E. Love, H. Krum, J. Nicolau, J. S. Cardoso, A. Parkhomenko, M. Aschermann, R. Corbalan, H. Solomon, et al. History of Hypertension and Eplerenone in Patients With Acute Myocardial Infarction Complicated by Heart Failure Hypertension, August 1, 2008; 52(2): 271 - 278. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. J. Shah, T. Thenappan, S. Rich, L. Tian, S. L. Archer, and M. Gomberg-Maitland Association of Serum Creatinine With Abnormal Hemodynamics and Mortality in Pulmonary Arterial Hypertension Circulation, May 13, 2008; 117(19): 2475 - 2483. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Ahmed, I. B Aban, V. Vaccarino, D. M Lloyd-Jones, D. C Goff Jr, J. Zhao, T. E Love, C. Ritchie, F. Ovalle, G. Gambassi, et al. A propensity-matched study of the effect of diabetes on the natural history of heart failure: variations by sex and age Heart, December 1, 2007; 93(12): 1584 - 1590. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Ashrafian, M. P. Frenneaux, and L. H. Opie Metabolic Mechanisms in Heart Failure Circulation, July 24, 2007; 116(4): 434 - 448. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Ahmed, F. Zannad, T. E. Love, J. Tallaj, M. Gheorghiade, O. J. Ekundayo, and B. Pitt A propensity-matched study of the association of low serum potassium levels and mortality in chronic heart failure Eur. Heart J., June 1, 2007; 28(11): 1334 - 1343. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Ahmed Digoxin and Reduction in Mortality and Hospitalization in Geriatric Heart Failure: Importance of Low Doses and Low Serum Concentrations J. Gerontol. A Biol. Sci. Med. Sci., March 1, 2007; 62(3): 323 - 329. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W.H. W. Tang and G. S. Francis The Year in Heart Failure J. Am. Coll. Cardiol., December 19, 2006; 48(12): 2575 - 2583. [Full Text] [PDF]
|
|