Loop diuretic therapy with or without heart failure: impact on prognosis.

Area of Science:

• Cardiology
• Pharmacology
• Public Health

Background:

• Many cardiovascular disease patients receive loop diuretics without a confirmed heart failure diagnosis.
• The characteristics and prognosis of these patients are not well understood.

Purpose of the Study:

• To investigate the association between loop diuretic use, heart failure diagnosis, and patient prognosis in cardiovascular disease.
• To determine mortality risks associated with loop diuretic prescription in the absence of a heart failure diagnosis.

Main Methods:

• Retrospective analysis of Glasgow regional health records (2009-2016).
• Inclusion of adult patients with cardiovascular disease or on loop diuretics.
• Cox proportional hazards models used to calculate adjusted hazard ratios (adjHR) for mortality.

Main Results:

• Out of 198,898 patients, 12% were on loop diuretics without a heart failure record.
• Five-year mortality was 40% for loop diuretic users without heart failure, versus 22% for controls.
• Mortality was highest (52%) for patients with both heart failure and loop diuretic use.

Conclusions:

• Loop diuretic prescription in cardiovascular disease patients is common without a heart failure diagnosis.
• Loop diuretic use, rather than a heart failure diagnosis alone, showed a stronger association with increased mortality.
• Potential reasons include missed heart failure diagnoses, comorbidities, or adverse effects of loop diuretics.