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Loop Diuretic Prescription and Long-Term Outcomes in Heart Failure: Association Modification by Congestion.

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Citation: American Journal of Medicine. 2020 Dec 23PMID: 33359271Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2020 Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - presentISSN:

0002-9343

Name of journal: The American journal of medicineAbstract: BACKGROUND: The effect of loop diuretics on clinical outcomes in heart failure has not been evaluated in randomized controlled trials. In hospitalized patients with heart failure, a discharge loop diuretic prescription has been shown to be associated with improved 30-day outcomes, which appears to be more pronounced in subgroups with congestion. In the current study, we examined these associations and association modifications during longer follow-up.CONCLUSIONS: The association between a discharge loop diuretic prescription and long-term clinical outcomes in hospitalized patients with heart failure is modified by admission congestion with worse, neutral, and better outcomes in patients with no, mild-to-moderate, and severe congestion, respectively. If these findings can be replicated, congestion may be used to risk-stratify patients with heart failure for potential optimization of loop diuretic prescription and outcomes. Copyright (c) 2020. Published by Elsevier Inc.METHODS: We assembled a propensity score-matched cohort of 2191 pairs of hospitalized heart failure patients discharged with versus without a prescription for loop diuretics balanced on 74 baseline characteristics (mean age, 78 years; 54% women; 11% African American).RESULTS: Hazard ratio (HR) and 95% confidence interval (CI) for 6-year combined endpoint of heart failure readmission or all-cause mortality was 1.02 (0.96-1.09). HRs and 95% CIs for this combined endpoint in patients with no, mild-to-moderate, and severe pulmonary rales were 1.19 (1.07-1.33), 0.95 (0.86-1.04), and 0.77 (0.63-0.94), respectively (p for interaction, <0.001). Respective HRs (95% CIs) for no, mild-to-moderate, and severe lower extremity edema were 1.16 (1.06-1.28), 0.94 (0.85-1.04), and 0.71 (0.56-0.89; interaction p, <0.001).All authors: Ahmed A, Allman RM, Arundel C, Deedwania P, Faselis C, Filippatos G, Fonarow GC, Lam PH, Nguyen T, Patel S, Wopperer S, Zile MRFiscal year: FY2021Digital Object Identifier:

https://dx.doi.org/10.1016/j.amjmed.2020.11.019

Date added to catalog: 2020-12-31

Holdings ( 1 )
Title notes ( 6 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	33359271	Available		33359271

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - present

BACKGROUND: The effect of loop diuretics on clinical outcomes in heart failure has not been evaluated in randomized controlled trials. In hospitalized patients with heart failure, a discharge loop diuretic prescription has been shown to be associated with improved 30-day outcomes, which appears to be more pronounced in subgroups with congestion. In the current study, we examined these associations and association modifications during longer follow-up.

CONCLUSIONS: The association between a discharge loop diuretic prescription and long-term clinical outcomes in hospitalized patients with heart failure is modified by admission congestion with worse, neutral, and better outcomes in patients with no, mild-to-moderate, and severe congestion, respectively. If these findings can be replicated, congestion may be used to risk-stratify patients with heart failure for potential optimization of loop diuretic prescription and outcomes. Copyright (c) 2020. Published by Elsevier Inc.

METHODS: We assembled a propensity score-matched cohort of 2191 pairs of hospitalized heart failure patients discharged with versus without a prescription for loop diuretics balanced on 74 baseline characteristics (mean age, 78 years; 54% women; 11% African American).

RESULTS: Hazard ratio (HR) and 95% confidence interval (CI) for 6-year combined endpoint of heart failure readmission or all-cause mortality was 1.02 (0.96-1.09). HRs and 95% CIs for this combined endpoint in patients with no, mild-to-moderate, and severe pulmonary rales were 1.19 (1.07-1.33), 0.95 (0.86-1.04), and 0.77 (0.63-0.94), respectively (p for interaction, <0.001). Respective HRs (95% CIs) for no, mild-to-moderate, and severe lower extremity edema were 1.16 (1.06-1.28), 0.94 (0.85-1.04), and 0.71 (0.56-0.89; interaction p, <0.001).

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