No Link Between Diuretic Dose and All Cause Mortality, Heart Failure

In multivariate analysis, no correlation seen for patients with worsening heart failure
In multivariate analysis, no correlation seen for patients with worsening heart failure

HealthDay News — For patients with worsening heart failure, after adjustment for pre-specified covariates of disease severity, diuretic dose is not associated with mortality and heart failure rehospitalization, according to a study published online March 30 in JACC: Heart Failure.

Alicia Mecklai, MD, from the Weill Medical College of Cornell University in New York City, and colleagues examined the correlation between loop diuretic dose-response and post-discharge outcomes among patients hospitalized for heart failure. Data were included for 3,037 patients hospitalized with worsening heart failure and enrolled in the EVEREST study (Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study with Tolvaptan).

The researchers found that exposure to high-dose versus low-dose diuretics correlated with increased risk of the combined outcome of 30-day post-discharge all-cause mortality and heart failure rehospitalization (18.9 versus 10.0%; hazard ratio, 2.00; 95% confidence interval, 1.64 to 2.46). The correlation between diuretic dose and outcome was no longer significant after adjustment for pre-specified covariates of disease severity (hazard ratio, 1.11; 95% confidence interval, 0.89 to 1.38). The correlation between diuretic exposure and the combined end point was not modified by congestion status at hospital discharge (interaction P=0.84).

"Short-term diuretic exposure during hospital treatment for worsening heart failure was not an independent predictor of 30-day all-cause mortality and heart failure rehospitalization in multivariable analysis," the authors write.

Several authors disclosed financial ties to Otsuka American Pharmaceuticals, which funded the EVEREST study.

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