Outcomes in patients treated with loop diuretics without a diagnosis of heart failure: a retrospective cohort study

Cuthbert, Joseph James; Soyiri, Ireneous; Lomax, Stephanie Jayne; Turgoose, John; Fuat, Ahmet; Cohen, Judith; Clark, Andrew L.

Abstract

Background Loop diuretics are commonly prescribed in the community, not always to patients with a recorded diagnosis of heart failure (HF). The rate of HF events in patients prescribed loop diuretics without a diagnosis of HF is unknown. Methods This was a propensity-matched cohort study using data from the Clinical Practice Research Datalink, Hospital Episode Statistics and Office of National Statistics in the UK. Patients prescribed a loop diuretic without a diagnosis of HF (loop diuretic group) between 1 January 2010 and 31 December 2015 were compared with patients with HF (HF group)-analysis A, and patients with risk factors for HF (either ischaemic heart disease, or diabetes and hypertension-at-risk group)-analysis B. The primary endpoint was an HF event (a composite of presentation with HF symptoms, HF hospitalisation, HF diagnosis (analysis B only) and all-cause mortality). Results From a total population of 180 384 patients (78 968 in the loop diuretic group, 28 177 in the HF group and 73 239 in the at-risk group), there were 59 694 patients, 22 352 patients and 57 219 patients in the loop diuretic, HF and at-risk groups, respectively, after exclusion criteria were applied. After propensity matching for age, sex and comorbidities, patients in the loop diuretic group had a similar rate of HF events as those in the HF group (71.9% vs 72.1%; HR=0.92 (95% CI 0.90 to 0.94); p<0.001), and twice as those in the at-risk group (59.2% vs 35.7%; HR=2.04 (95% CI 2.00 to 2.08); p<0.001). Conclusions Patients prescribed a loop diuretic without a recorded diagnosis of HF experience HF events at a rate comparable with that of patients with a recorded diagnosis of HF; many of these patients may have undiagnosed HF.

Citation

Cuthbert, J. J., Soyiri, I., Lomax, S. J., Turgoose, J., Fuat, A., Cohen, J., & Clark, A. L. (2024). Outcomes in patients treated with loop diuretics without a diagnosis of heart failure: a retrospective cohort study. Heart, 110(12), 854-862. https://doi.org/10.1136/heartjnl-2023-323577

• Journal Article Type: Article
• Acceptance Date: Mar 15, 2024
• Online Publication Date: Apr 17, 2024
• Publication Date: Jun 1, 2024
• Deposit Date: Apr 22, 2024
• Publicly Available Date: Jun 4, 2024
• Journal: Heart
• Print ISSN: 1355-6037
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 110
• Issue: 12
• Article Number: 323577
• Pages: 854-862
• DOI: https://doi.org/10.1136/heartjnl-2023-323577
• Keywords: Cardiology and Cardiovascular Medicine
• Public URL: https://hull-repository.worktribe.com/output/4628804