A propensity-matched study of the effects of chronic diuretic therapy
on mortality and hospitalization in older adults with heart failure

Ali Ahmeda, , , James B. Youngb, Thomas E. Lovec, Raynald Levesqued
and Betram Pitte
aUniversity of Alabama at Birmingham, and Veterans Affairs Medical
Center, Birmingham, 1530 3rd Avenue South, CH19-219, Birmingham,
Alabama, USA
bCleveland Clinic Foundation, Cleveland, Ohio, USA
cCase Western Reserve University, Cleveland, Ohio, USA
dAon Consulting, Montreal, Canada
eUniversity of Michigan, Ann Arbor, Michigan, USA

Background

Non-potassium-sparing diuretics may increase mortality and
hospitalizations in heart failure patients. Most heart failure
patients are older adults, yet the effect of diuretics on cause-
specific mortality and hospitalizations in older adults with heart
failure is unknown. The objective of this propensity-matched study was
to determine the effect of diuretics on mortality and hospitalizations
in heart failure patients ≥ 65 years.

Methods

Of the 7788 Digitalis Investigation Group participants, 4036 were ≥ 65
years and 3271 (81%) were receiving diuretics. Propensity scores for
diuretic use for each of the 4036 patients were calculated using a non-
parsimonious multivariable logistic regression model incorporating all
measured baseline covariates, and were used to match 651 (85%)
patients not receiving diuretics with 651 patients receiving
diuretics. Effects of diuretics on mortality and hospitalization at 37
months of median follow-up were assessed using matched Cox regression
models.

Results

All-cause mortality occurred in 173 patients not receiving diuretics
and 208 patients receiving diuretics respectively during 2056 and 1943
person-years of follow-up (hazard ratio {HR} = 1.36; 95% confidence
interval {CI} = 1.08–1.71; p = 0.009). All-cause hospitalizations
occurred in 413 patients not receiving and 438 patients receiving
diuretics respectively during 1255 and 1144 person-years of follow-up
(HR = 1.18; 95% CI = 0.99–1.39; p = 0.063). Diuretic use was
associated with significant increased risk of cardiovascular mortality
(HR = 1.50; 95% CI = 1.15–1.96; p = 0.003).and heart failure
hospitalization (HR = 1.48; 95% CI = 1.13–1.94; p = 0.005).

Conclusions

Chronic diuretic use was associated with significant increased
mortality and hospitalization in ambulatory older adults with heart
failure receiving angiotensin converting enzyme inhibitor and
diuretics.

Corresponding author. University of Alabama at Birmingham, 1530 3rd
Ave South, CH-19, Ste-219, Birmingham AL 35294-2041, USA. Tel.: +1 205
934 9632; fax: +1 205 975 7099.

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I don't understand this.  If diuretics have such bad effects in these
patients, why are they prescribed them?  I'll have to look into this
further.

Marilyn