Loop and thiazide diuretics and outcomes in heart failure with preserved ejection fraction
Key result
Baseline loop diuretic monotherapy in HFpEF linked to ~59% higher risk of CV death and HHF.
- HR 1.59
- 95% CI 1.23-2.07
- P<0.001
- n=1,765
Why the study?
Trials in HFpEF frequently use baseline diuretic use as an enrichment criterion, but the role of thiazides and loop diuretic dose for enrichment remains unclear.
Does baseline loop and/or thiazide diuretic use affect the risk of cardiovascular death and heart failure hospitalizations in patients with HFpEF?
Population
1765 patients with HFpEF from TOPCAT-Americas
Comparison
Baseline loop diuretic monotherapy, thiazide monotherapy, or combined therapy vs no diuretic use
Design
Post-hoc analysis of a randomized trial
Follow-up
Median of 2.9 years
Authors
Discussion
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Member takes
Implication
Observational diuretic associations in HFpEF should not change prescribing; leaves open confounding by severity and need for trials.
Study Design
Type
Observational (n=1,765)
Multicenter
Yes
Structured PICO
Does baseline loop and/or thiazide diuretic use affect the risk of cardiovascular death and heart failure hospitalizations in patients with HFpEF?
P
Population
1765 patients with heart failure with preserved ejection fraction (HFpEF) from the TOPCAT-Americas cohort
I
Intervention
Baseline loop diuretic monotherapy, thiazide monotherapy, or combined loop and thiazide diuretic therapy
C
Comparator
No diuretic use
O
Outcome
Cardiovascular death and total hospitalizations for heart failure (HHF)composite
Main Result
Effect estimate: HR 1.59 (95% CI 1.23-2.07)
p-value: p=<0.001
In patients with HFpEF, baseline use and higher doses of loop diuretics, especially when combined with thiazides, are associated with an increased risk of cardiovascular death and heart failure hospitalizations.
Cite This Study
Szabó‐Söderberg et al. (2025) conducted an observational in Heart failure with preserved ejection fraction (HFpEF) (n=1,765). Loop diuretic monotherapy and combined loop and thiazide diuretic therapy vs. No diuretic use was evaluated on CV death and total hospitalizations for heart failure (HHF) (HR 1.59, 95% CI 1.23-2.07, p=<0.001). Baseline loop diuretic monotherapy and combined loop+thiazide therapy in HFpEF were associated with higher risk of CV death and HHFs (HR 1.59 and HR 2.07 respectively; p<0.001).