TY - JOUR
TI - Loop Diuretic Prescription and Long-Term Outcomes in Heart Failure: Association Modification by Congestion
AU - Faselis, C.
AU - Lam, P.H.
AU - Patel, S.
AU - Arundel, C.
AU - Filippatos, G.
AU - Deedwania, P.
AU - Zile, M.R.
AU - Wopperer, S.
AU - Nguyen, T.
AU - Allman, R.M.
AU - Fonarow, G.C.
AU - Ahmed, A.
JO - AMERICAN JOURNAL OF MEDICINE
PY - 2021
VL - 134
TODO - 6
SP - 797-804
PB - HANLEY & BELFUS-ELSEVIER INC
SN - 0002-9343
TODO - 10.1016/j.amjmed.2020.11.019
TODO - aldosterone antagonist;  angiotensin receptor antagonist;  beta adrenergic receptor blocking agent;  digoxin;  dipeptidyl carboxypeptidase inhibitor;  loop diuretic agent;  loop diuretic agent, African American;  age distribution;  aged;  all cause mortality;  Article;  clinical feature;  cohort analysis;  congestive heart failure;  controlled study;  crackle;  disease severity;  drug efficacy;  female;  follow up;  heart failure;  hospital discharge;  hospital readmission;  human;  leg edema;  long term outcome;  major clinical study;  male;  observational study;  outcome assessment;  prescription;  propensity score;  risk assessment;  sex difference;  treatment outcome;  complication;  heart failure;  hospitalization;  mortality;  procedures;  proportional hazards model;  time;  very elderly, Aged;  Aged, 80 and over;  Cohort Studies;  Female;  Heart Failure;  Hospitalization;  Humans;  Male;  Mortality;  Outcome Assessment, Health Care;  Propensity Score;  Proportional Hazards Models;  Sodium Potassium Chloride Symporter Inhibitors;  Time
TODO - Background: The effect of loop diuretics on clinical outcomes in heart failure has not been evaluated in randomized controlled trials. In hospitalized patients with heart failure, a discharge loop diuretic prescription has been shown to be associated with improved 30-day outcomes, which appears to be more pronounced in subgroups with congestion. In the current study, we examined these associations and association modifications during longer follow-up. Methods: We assembled a propensity score-matched cohort of 2191 pairs of hospitalized heart failure patients discharged with, vs without, a prescription for loop diuretics, balanced on 74 baseline characteristics (mean age 78 years; 54% women; 11% African American). Results: Hazard ratio (HR) and 95% confidence interval (CI) for 6-year combined endpoint of heart failure readmission or all-cause mortality was 1.02 (0.96-1.09). HRs and 95% CIs for this combined endpoint in patients with no, mild-to-moderate, and severe pulmonary rales were 1.19 (1.07-1.33), 0.95 (0.86-1.04), and 0.77 (0.63-0.94), respectively (P for interaction, <.001). Respective HRs (95% CIs) for no, mild-to-moderate, and severe lower extremity edema were 1.16 (1.06-1.28), 0.94 (0.85-1.04), and 0.71 (0.56-0.89; interaction P <.001). Conclusions: The association between a discharge loop diuretic prescription and long-term clinical outcomes in hospitalized patients with heart failure is modified by admission congestion with worse, neutral, and better outcomes in patients with no, mild-to-moderate, and severe congestion, respectively. If these findings can be replicated, congestion may be used to risk-stratify patients with heart failure for potential optimization of loop diuretic prescription and outcomes. © 2020
ER -