Congestion modifies association between loop diuretic prescription, outcomes in heart failure

Admission congestion with worse, neutral, and better outcomes in patients with no, mild-to-moderate, and severe congestion, respectively, modifies the association between a discharge loop diuretic prescription and long-term clinical outcomes in hospitalized patients with heart failure, reveals a study.

“In hospitalized patients with heart failure, a discharge loop diuretic prescription has been shown to be associated with improved 30-day outcomes, which appears to be more pronounced in subgroups with congestion,” the authors said.

This study examined such correlation as well as association modifications during longer follow-up. The authors assembled a propensity score-matched cohort of 2,191 pairs of hospitalized heart failure patients discharged with vs without a prescription for loop diuretics, balanced on 74 baseline characteristics (mean age 78 years, 54 percent women, 11 percent African American).

For the 6-year combined endpoint of heart failure readmission or all-cause mortality, the hazard ratio (HR) was 1.02 (95 percent confidence interval [CI], 0.96–1.09). In patients with no, mild-to-moderate, and severe pulmonary rales, the HRs for the combined endpoint were 1.19 (95 percent CI, 1.07–1.33), 0.95 (95 percent CI, 0.86–1.04), and 0.77 (95 percent CI, 0.63–0.94), respectively (p_interaction<0.001).

For no, mild-to-moderate, and severe lower extremity oedema, the HRs were 1.16 (95 percent CI, 1.06–1.28), 0.94 (95 percent CI, 0.85–1.04), and 0.71 (95 percent CI, 0.56–0.89), respectively (p_interaction<0.001).

“If these findings can be replicated, congestion may be used to risk-stratify patients with heart failure for potential optimization of loop diuretic prescription and outcomes,” the authors said.