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Association of diuretic treatment at hospital discharge in patients with heart failure with all-cause short- and long-term mortality: A propensity score-matched analysis from SwedeHF

Journal article
Authors Pär Parén
U. Dahlström
M. Edner
Georg Lappas
Annika Rosengren
Maria Schaufelberger
Published in International Journal of Cardiology
Volume 257
Pages 118-124
ISSN 0167-5273
Publication year 2018
Published at Institute of Medicine
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 118-124
Language en
Links https://doi.org/10.1016/j.ijcard.20...
Keywords Diuretics, Heart failure, Inpatients, Mortality
Subject categories Cardiac and Cardiovascular Systems

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: 2.85 years) 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.

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