%A Jocelyn M. Friday
%A John Cleland
%A Pierpaolo Pellicori
%A Maria Wolters
%A John J.V. McMurray
%A Pardeep S. Jhund
%A Paul Forsyth
%A David A. McAllister
%A Fraser J. Graham
%A Yola Jones
%A Jim Lewsey
%O JMF's PhD funding was provided by the Institute of Health and Wellbeing and the College of Medical, Veterinary, and Life Sciences at the University of Glasgow. JMF, JJVM, JGFC, and PSJ are supported by a British Heart Foundation Centre for Research Excellence Grant (grant number RE/18/6/34217), JJVM and PSJ by the Vera Melrose Heart Failure Research Fund. PP received a Scotland research grant from Heart Research UK (grant number RG2676/18/21).
%J European Heart Journal
%T Loop diuretic utilisation with or without heart failure: impact on prognosis
%X Background and Aims:

Many patients are prescribed loop diuretics without a diagnostic record of heart failure. Little is known about their characteristics and prognosis.

Methods:

Glasgow regional health records (2009-2016) were obtained for adults with cardiovascular disease or taking loop diuretics. Outcomes were investigated using Cox models with hazard ratios adjusted for age, sex, socioeconomic deprivation, and co-morbid disease (adjHR).

Results:

Of 198,898 patients (median age 65 years; 55% women), 161,935 (81%) neither took loop diuretics nor had a diagnostic record of heart failure (reference group), 23,963 (12%) were taking loop diuretics but had no heart failure recorded, 7,844 (4%) had heart failure recorded and took loop diuretics and 5,156 (3%) had heart failure recorded but were not receiving loop diuretics.

Five-year mortality was only slightly higher for heart failure in absence of loop diuretics (22%; adjHR: 1.2 [95% CI 1.1-1.3]), substantially higher for those taking loop diuretics with no heart failure recorded (40%; adjHR: 1.8 [95% CI 1.7-1.8]) and highest for heart failure treated with loop diuretics (52%; adjHR: 2.2 [95% CI 2.0-2.2]).

Conclusions:

For patients with cardiovascular disease, many are prescribed loop diuretics without a diagnosis of heart failure being recorded. Mortality is more strongly associated with loop diuretic use than with a heart failure record. The diagnosis of heart failure may be often missed, or loop diuretic use is associated with other conditions with a prognosis similar to heart failure, or inappropriate loop diuretic use increases mortality; all might be true.
%D 2024
%R 10.1093/eurheartj/ehae345
%I Oxford University Press (OUP) on behalf of European Society of Cardiology
%L enlighten326396