Key result
Diuretic treatment at hospital discharge was not associated with 90-day mortality (HR 0.89; 95% CI 0.74-1.07) but was associated with increased long-term mortality (HR 1.15; 95% CI 1.06-1.24).
Why the study?
Does diuretic treatment at hospital discharge reduce short- and long-term all-cause mortality in patients with heart failure?
Cohort (n=26,218)
Yes
Does diuretic treatment at hospital discharge reduce short- and long-term all-cause mortality in patients with heart failure?
Diuretic treatment at hospital discharge in heart failure patients is associated with increased long-term mortality, likely serving as a marker of disease severity and congestion rather than a causal factor for harm.
Answers are grounded in this paper and cite their sources.
Diuretics at HF discharge should not yet change practice; leaves open whether long-term mortality link reflects severity or harm.
AIMS: Diuretics are recommended for treating congestive symptoms in heart failure (HF). The short- and long-term prognostic effects of diuretic treatment at hospital discharge have not been studied in randomized clinical trials or in a Western world population. We aimed to determine the association of diuretic treatment at discharge with the risk of short-and long-term all-cause mortality in real-life patients in Sweden with HF irrespective of EF. METHODS AND RESULTS: From a Swedish nationwide HF register 26,218 patients discharged from hospital were included in the present study. A total of 87% of patients were treated with and 13% were not treated with diuretics at hospital discharge. In a 1:1 propensity score-matched cohort of 6564 patients, the association of diuretic treatment at hospital discharge with the risk of 90-day all-cause mortality was neutral (HR 0.89, 95% CI 0.74-1.07, p=0.21) whereas the risk of long-term all-cause mortality (median follow-up: 2.85years) was increased (HR 1.15, 95% CI 1.06-1.24, p<0.001). CONCLUSION: Diuretic treatment at hospital discharge was not associated with short-term mortality whereas it was associated with increased long-term mortality. Although we accounted for a wide range of clinical features, measured or unmeasured factors could still explain this increase in risk. However, our results suggest that diuretic treatment at hospital discharge may be regarded as a marker of increased long-term mortality.
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Parén et al. (2018) conducted a cohort in Heart failure (n=26,218). Diuretic treatment at hospital discharge vs. No diuretic treatment at hospital discharge was evaluated on 90-day all-cause mortality (HR 0.89, 95% CI 0.74-1.07, p=0.21). Diuretic treatment at hospital discharge was not associated with 90-day mortality (HR 0.89; 95% CI 0.74-1.07) but was associated with increased long-term mortality (HR 1.15; 95% CI 1.06-1.24).
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