Discharge prescription of loop diuretics in older patients hospitalized for heart failure was associated with lower 30-day all-cause mortality compared to nonuse (HR 0.73; 95% CI 0.57-0.94; p=0.016).
Cohort (n=4,382)
Yes
Does loop diuretic prescription at discharge reduce 30-day mortality and readmission in older patients hospitalized for heart failure?
In older, diuretic-naive patients hospitalized for heart failure, prescribing loop diuretics at discharge is associated with improved 30-day survival and reduced heart failure readmissions.
Hazard Ratio: 0.73 (95% CI 0.57–0.94)
Absolute Event Rate: 4.9% vs 6.6%
p-value: p=0.016
BACKGROUND Heart failure (HF) is a major source of morbidity and mortality. Fluid retention and shortness of breath are its cardinal manifestations for which loop diuretics are used. Although their usefulness is well accepted, less is known about their role in improving clinical outcomes. OBJECTIVES To determine the relationship between loop diuretics and clinical outcomes in patients with HF. METHODS Of the 25,345 older patients hospitalized for HF in Medicare-linked OPTIMIZE-HF registry, 9,866 (39%) received no pre-admission diuretics. We excluded 1,083 patients receiving dialysis and 847 discharged on thiazide diuretics. Of the remaining 7,936 patients, 5,568 (70%) were prescribed loop diuretics at discharge. Using propensity scores for receipt of loop diuretics estimated for each of the 7,936 patients, we assembled a matched cohort of 2,191 pairs of patients, balanced on 74 baseline characteristics. Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes were estimated in the matched cohort. RESULTS Matched patients (N=4,382) had a mean age of 78 years, 54% were women, and 11% African American. 30-day all-cause mortality occurred in 4.9% (107/2,191) and 6.6% (144/2,191) of patients in the loop diuretic and no loop diuretic groups, respectively (HR when the use of loop diuretics was compared to their nonuse, 0.73; 95% CI, 0.57–0.94; p=0.016). Patients in the loop diuretic group had a significantly lower risk of 30-day HF readmission (HR, 0.79; 95% CI, 0.63–0.99; p=0.037) but not of 30-day all-cause readmission (HR, 0.89; 95% CI, 0.79–1.01; p=0.081). None of the associations was statistically significant during 60 days of follow-up. CONCLUSION Hospitalized older patients not taking diuretics prior to hospitalization for HF decompensation who received a discharge prescription for loop diuretics had significantly better 30-day clinical outcomes than those not discharged on loop diuretics. These findings provide new information about short-term clinical benefits associated with loop diuretic use in HF.
Faselis et al. (Sat,) conducted a cohort in Heart failure (n=4,382). Loop diuretics vs. No loop diuretics was evaluated on 30-day all-cause mortality (HR 0.73, 95% CI 0.57-0.94, p=0.016). Discharge prescription of loop diuretics in older patients hospitalized for heart failure was associated with lower 30-day all-cause mortality compared to nonuse (HR 0.73; 95% CI 0.57-0.94; p=0.016).
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