Loop diuretic utilisation with or without heart failure: impact on prognosis (original) (raw)
Friday, J. M. et al. (2024) Loop diuretic utilisation with or without heart failure: impact on prognosis.European Heart Journal, 45(37), pp. 3837-3849. (doi: 10.1093/eurheartj/ehae345) (PMID:38845446) (PMCID:PMC11452746)
Abstract
Background and Aims: Many patients are prescribed loop diuretics without a diagnostic record of heart failure. Little is known about their characteristics and prognosis. Methods: Glasgow regional health records (2009-2016) were obtained for adults with cardiovascular disease or taking loop diuretics. Outcomes were investigated using Cox models with hazard ratios adjusted for age, sex, socioeconomic deprivation, and co-morbid disease (adjHR). Results: Of 198,898 patients (median age 65 years; 55% women), 161,935 (81%) neither took loop diuretics nor had a diagnostic record of heart failure (reference group), 23,963 (12%) were taking loop diuretics but had no heart failure recorded, 7,844 (4%) had heart failure recorded and took loop diuretics and 5,156 (3%) had heart failure recorded but were not receiving loop diuretics. Five-year mortality was only slightly higher for heart failure in absence of loop diuretics (22%; adjHR: 1.2 [95% CI 1.1-1.3]), substantially higher for those taking loop diuretics with no heart failure recorded (40%; adjHR: 1.8 [95% CI 1.7-1.8]) and highest for heart failure treated with loop diuretics (52%; adjHR: 2.2 [95% CI 2.0-2.2]). Conclusions: For patients with cardiovascular disease, many are prescribed loop diuretics without a diagnosis of heart failure being recorded. Mortality is more strongly associated with loop diuretic use than with a heart failure record. The diagnosis of heart failure may be often missed, or loop diuretic use is associated with other conditions with a prognosis similar to heart failure, or inappropriate loop diuretic use increases mortality; all might be true.
| Item Type: | Articles |
|---|---|
| Additional Information: | JMF's PhD funding was provided by the Institute of Health and Wellbeing and the College of Medical, Veterinary, and Life Sciences at the University of Glasgow. JMF, JJVM, JGFC, and PSJ are supported by a British Heart Foundation Centre for Research Excellence Grant (grant number RE/18/6/34217), JJVM and PSJ by the Vera Melrose Heart Failure Research Fund. PP received a Scotland research grant from Heart Research UK (grant number RG2676/18/21). |
| Keywords: | Diuretics, heart failure, ejection fraction, left atrium, epidemiology, mortality. |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Graham, Dr Fraser and Friday, Dr Jocelyn and Jhund, Professor Pardeep and McAllister, Professor David and Wolters, Dr Maria and Lewsey, Professor Jim and Cleland, Professor John and McMurray, Professor John and Pellicori, Dr Pierpaolo and Jones, Yola |
| Authors: | Friday, J. M., Cleland, J., Pellicori, P., Wolters, M., McMurray, J. J.V., Jhund, P. S., Forsyth, P., McAllister, D. A., Graham, F. J., Jones, Y., and Lewsey, J. |
| College/School: | College of Medical Veterinary and Life SciencesCollege of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic HealthCollege of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary CareCollege of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment |
| Journal Name: | European Heart Journal |
| Publisher: | Oxford University Press (OUP) on behalf of European Society of Cardiology |
| ISSN: | 0195-668X |
| ISSN (Online): | 1522-9645 |
| Published Online: | 07 June 2024 |
| Copyright Holders: | Copyright © 2024 The Authors |
| First Published: | First published in European Heart Journal 45(37):3837-3849 |
| Publisher Policy: | Reproduced under a Creative Commons License |
University Staff: Request a correction | Enlighten Editors: Update this record
Funder and Project Information
BHF Centre of Excellence
Colin Berry
RE/18/6/34217
SCMH - Cardiovascular & Metabolic Health
Deposit and Record Details
| ID Code: | 326396 |
|---|---|
| Depositing User: | Mrs Nora Helle |
| Datestamp: | 03 Jun 2024 10:09 |
| Last Modified: | 16 Apr 2025 14:43 |
| Date of acceptance: | 16 May 2024 |
| Date of first online publication: | 7 June 2024 |
| Date Deposited: | 10 June 2024 |
| Data Availability Statement: | Yes |