eprintid: 326396 rev_number: 38 eprint_status: archive userid: 72189 dir: disk0/00/32/63/96 datestamp: 2024-06-03 10:09:54 lastmod: 2025-03-05 14:13:25 status_changed: 2024-06-10 09:39:50 type: article metadata_visibility: show creators_name: Friday, Jocelyn M. creators_name: Cleland, John creators_name: Pellicori, Pierpaolo creators_name: Wolters, Maria creators_name: McMurray, John J.V. creators_name: Jhund, Pardeep S. creators_name: Forsyth, Paul creators_name: McAllister, David A. creators_name: Graham, Fraser J. creators_name: Jones, Yola creators_name: Lewsey, Jim creators_orcid: 0000-0002-1658-3883 creators_orcid: 0000-0002-1471-7016 creators_orcid: 0000-0001-7175-0464 creators_orcid: 0000-0002-6317-3975 creators_orcid: 0000-0003-4306-5317 creators_orcid: 0000-0003-3550-1764 creators_orcid: 0000-0002-3811-8165 title: Loop diuretic utilisation with or without heart failure: impact on prognosis ispublished: early divisions: 25200000 divisions: 20000000 divisions: 25601000 divisions: 25604000 full_text_status: public note: 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). suggestions: DOI not yet resolving. 2024-05-21 AA: 10.1093/eurheartj/ehae345 Status checks: 2024-06-03 NH NYP abstract: 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. date: 2024-06-07 date_type: published_online publication: European Heart Journal publisher: Oxford University Press (OUP) on behalf of European Society of Cardiology id_number: 10.1093/eurheartj/ehae345 refereed: TRUE issn: 0195-668X copyright_holders: Copyright © 2024 The Authors prior: First published in European Heart Journal 2024 repro: Reproduced under a Creative Commons License uniqueid: glaseprints:2024-326396 issn_online: 1522-9645 funding_project_code: 303944 funding_project_name: BHF Centre of Excellence funding_investigator_name: Colin Berry funding_funder_name: British Heart Foundation (BHF) funding_funder_code: RE/18/6/34217 funding_investigator_dept: SCMH - Cardiovascular & Metabolic Health pubmed_id: 38845446 euro_pubmed_id: 38845446 hoa_compliant: 9215 hoa_ref_pan: AB hoa_date_acc: 2024-05-16 hoa_date_pub: 2024-06-07 hoa_date_foa: 2024-06-10 hoa_version_fcd: AM hoa_exclude: FALSE hoa_gold: TRUE oa_research_materials_ack: Yes rioxx2_license_ref_input_license_ref: https://creativecommons.org/licenses/by/4.0/ rioxx2_license_ref_input_start_date: 2024-06-07 citation: Friday, J. M. et al. (2024) Loop diuretic utilisation with or without heart failure: impact on prognosis. European Heart Journal , (doi: 10.1093/eurheartj/ehae345 ) (PMID:38845446) (Early Online Publication) document_url: https://eprints.gla.ac.uk/326396/1/326396.pdf