Pär Parén1, Ulf Dahlström2, Magnus Edner3, Georgios Lappas4, Annika Rosengren4, Maria Schaufelberger4. 1. Department of Internal Medicine, Sahlgrenska University Hospital/Mölndal, Mölndal, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden. Electronic address: par.paren@vgregion.se. 2. Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. 3. Karolinska Institute, Department of Medicine, Unit of Cardiology, N3:06, Karolinska University Hospital, Stockholm, Sweden. 4. Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
Abstract
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.
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.
Authors: Alice M Jackson; Pooja Dewan; Inder S Anand; Jan Bělohlávek; Olof Bengtsson; Rudolf A de Boer; Michael Böhm; David W Boulton; Vijay K Chopra; David L DeMets; Kieran F Docherty; Andrej Dukát; Peter J Greasley; Jonathan G Howlett; Silvio E Inzucchi; Tzvetana Katova; Lars Køber; Mikhail N Kosiborod; Anna Maria Langkilde; Daniel Lindholm; Charlotta E A Ljungman; Felipe A Martinez; Eileen O'Meara; Marc S Sabatine; Mikaela Sjöstrand; Scott D Solomon; Sergey Tereshchenko; Subodh Verma; Pardeep S Jhund; John J V McMurray Journal: Circulation Date: 2020-07-16 Impact factor: 29.690