Incident loop diuretic use in T2DM patients closely predicts heart failure, with models showing C-index ~0.87-0.88 and consistent validation in Scotland cohort.
Are the clinical characteristics that predict initiation of loop diuretics similar to those that predict incident heart failure in patients with type-2 diabetes mellitus?
In patients with T2DM, the clinical characteristics predicting new loop diuretic prescriptions closely mirror those predicting incident heart failure, suggesting new loop diuretic use may indicate unrecognized heart failure.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Heart Failure (HF) Guidelines strongly recommend (Class I) loop diuretics for managing symptoms and signs of congestion due to HF. However, many patients without a diagnosis of HF are prescribed loop diuretics. Such patients have a poor prognosis. Many may have a missed diagnosis of HF. Aim To identify characteristics that predict initiation of loop diuretics and investigate whether they are similar to those that predict incident HF. Methods We obtained electronic medical records (EMRs) of patients with type-2 diabetes mellitus (T2DM) from two populations (Hong Kong, China 50 years, 3,008 (1.4%) patients were newly prescribed loop diuretics and 3,658 had incident heart failure between 2009 – 2019. The models showed strong predictive performance (loop diuretic without HF: C-index: 0.87, Brier: 0.03) and (loop diuretic with HF: C-Index: 0.88, Brier 0.03). Table 1 shows the key predictors including age, eGFR, serum albumin and cardiovascular comorbidities. The model predicting incident loop diuretics with HF showed improved performance indicating that HF status is closely aligned with factors predicting loop diuretic initiation. Table 2 shows validation in an independent, diverse population demonstrated consistent predictive performance and similar key risk factors, further supporting the robustness of loop diuretic prescriptions as an early indicator of HF development. Conclusion Patients newly prescribed loop diuretics have clinical characteristics consistent with HF.Table 1:Predictors of LD (Hong Kong) Table 2:Predictors of LD (Scotland)
Kaur et al. (Sat,) reported a other. Incident loop diuretic use in T2DM patients closely predicts heart failure, with models showing C-index ~0.87-0.88 and consistent validation in Scotland cohort.