Diuretic Intensity Score and Mortality in Hospitalized Heart Failure Patients: A Multicenter Propensity‐Matched Analysis

ABSTRACT Aims To develop and evaluate a novel Diuretic Intensity Score (DIS) and investigate its relationship with mortality in hospitalized heart failure patients. Methods We analyzed propensity‐matched data from two independent cohorts: MIMIC‐IV ( n = 15 942) and the China Regional Heart Failure Database ( n = 1884). DIS was calculated based on diuretic types, routes, and combinations. Primary and secondary outcomes were 28‐ and 90‐day all‐cause mortality. Results Higher DIS was significantly associated with reduced 28‐day mortality (Severe vs. Mild: HR 0.27, p < 0.001 in MIMIC‐IV; HR 0.10, p < 0.001 in Chinese cohort) and 90‐day mortality. Restricted cubic spline analysis revealed an inverse, non‐linear relationship, with mortality risk decreasing as intensity increased and then plateauing. Conclusions In this propensity‐matched analysis of two independent cohorts, a higher DIS was associated with lower 28‐ and 90‐day all‐cause mortality in hospitalized heart failure patients. Given the observational design, these findings should be regarded as hypothesis‐generating associations rather than evidence of a causal benefit and require confirmation in prospective randomized trials before any change in clinical practice can be recommended.