New prescription for loop diuretic improves 30-day heart failure outcomes


Background: In patients with heart failure, loop diuretics are used to manage symptoms. However, the effect of loop diuretics on morbidity and mortality is not well studied.

Dr. Peter Wallenhorst

Study design: Retrospective matched cohort study.

Setting: OPTIMIZE-HF registry.

Synopsis: Using the data from the OPTIMIZE-HF registry to develop a matched cohort of 2,191 pairs of patients, researchers showed that patients hospitalized for heart failure who were not previously taking any diuretic had significantly better 30-day clinical outcomes if they were discharged on a loop diuretic. Specifically, a loop diuretic on discharge resulted in a lower 30-day all-cause mortality (hazard ratio, 0.73; 95% CI, 0.57-0.94; P = .016) and a lower risk of 30-day heart failure readmission (HR, 0.79; 95% CI, 0.63-0.99; P = .037), compared with patients not discharged on a loop diuretic.

Neither of these associations was statistically significant during a 60-day follow-up, and the authors acknowledge that significant 30-day associations may be sensitive to an unmeasured confounder.

Bottom line: Starting an outpatient loop diuretic on discharge for patients hospitalized for heart failure improves 30-day all-cause mortality and lowers the risk of 30-day heart failure readmission.

Citation: Faselis C et al. Loop diuretic prescription and 30-day outcomes in older patients with heart failure. J Am Coll Cardiol. 2020;76:669-79.

Dr. Wallenhorst is a hospitalist and palliative medicine physician at the Lexington (Ky) VA Health Care System.

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