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Diuretic use, progressive heart failure, and death in patients in the DIG study

Michael Domanski1, Xin Tian, Mark Haigney

  • 1Clinical Trials Group, Blood Institute, Bethesda, Maryland, USA.

Journal of Cardiac Failure
|June 10, 2006
PubMed

Insights

Nonpotassium-sparing diuretics (NPSDs) increase risks for sudden cardiac death and heart failure hospitalizations in heart failure patients. Potassium-sparing diuretics (PSDs) did not show increased risks compared to no diuretic.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Nonpotassium-sparing diuretics (NPSDs) are linked to increased sudden cardiac death (SCD) and progressive heart failure (HF) mortality in HF patients.
  • The comparative risks of different diuretic classes in HF management remain an area of investigation.

Purpose of the Study:

  • To evaluate the association between nonpotassium-sparing diuretics (NPSDs) and adverse cardiovascular outcomes in heart failure (HF) patients.
  • To compare the risks associated with NPSDs, potassium-sparing diuretics (PSDs), and no diuretic use in HF patients.

Main Methods:

  • Analysis of data from 6797 patients in the Digitalis Investigation Group study.
  • Calculation of risk ratios for death, cardiovascular death (CVD), progressive HF death, SCD, and HF hospitalization.
  • Comparison of outcomes among patients taking PSDs, NPSDs, or no diuretic.

Main Results:

  • NPSD use was associated with significantly increased risks of death (RR 1.36), CVD (RR 1.38), progressive HF death (RR 1.41), SCD (RR 1.67), and HF hospitalization (RR 1.68) compared to no diuretic.
  • No significant differences in adverse events were observed for patients taking only PSDs compared to no diuretic.
  • Patients on PSDs alone had a lower risk of HF hospitalization than those on NPSDs (RR 0.71).

Conclusions:

  • NPSDs are associated with a higher risk of mortality, cardiovascular death, progressive HF death, SCD, and HF hospitalization in HF patients.
  • Further randomized trials are necessary to definitively compare the safety and efficacy of NPSDs versus PSDs in HF management.
Abstract

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