Loop diuretic use at discharge is associated with adverse outcomes in hospitalized patients with heart failure - A report from the Japanese cardiac registry of heart failure in cardiology (JCARE-CARD) -

Sanae Hamaguchi, Shintaro Kinugawa, Miyuki Tsuchihashi-Makaya, Daisuke Goto, Satoshi Yamada, Hisashi Yokoshiki, Akira Takeshita, Hiroyuki Tsutsui

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Abstract

Background: Loop diuretics are commonly used in patients with heart failure (HF) to remove retained fluid and improve symptoms. However, they may potentially worsen outcomes in HF. It remains unknown whether the use of loop diuretics is associated with adverse HF outcomes in routine clinical practice. We thus determined the effects of loop diuretic use at discharge on long-term mortality and rehospitalization among patients hospitalized with HF. Methods and Results: The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) prospectively studied the characteristics and treatments of a broad sample of patients hospitalized with worsening HF and followed for 2.1 years. Among a total of 2,549 HF patients, loop diuretics were used by 2,015 patients (79%), but not 534 patients (21%). The mean age was 70.7 years and 60% were male. Etiology was ischemic in 32% and mean left ventricular ejection fraction was 42%. After adjustment for covariates, discharge use of loop diuretics was associated with significant adverse risks of cardiac death (adjusted hazard ratio [HR] 2.348, 95% confidence interval [CI] 1.246-4.423, P=0.008) and rehospitalization (adjusted HR 1.427, 95% CI 1.040-1.959, P=0.027). Conclusions: Among patients hospitalized with worsening HF, loop diuretic use at discharge was associated with long-term adverse outcomes, which suggests that routine chronic use of loop diuretics may be harmful for patients with HF.

Original languageEnglish
Pages (from-to)1920-1927
Number of pages8
JournalCirculation Journal
Volume76
Issue number8
DOIs
Publication statusPublished - Aug 2 2012

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Sodium Potassium Chloride Symporter Inhibitors
Cardiology
Registries
Heart Failure
Confidence Intervals
Stroke Volume

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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Loop diuretic use at discharge is associated with adverse outcomes in hospitalized patients with heart failure - A report from the Japanese cardiac registry of heart failure in cardiology (JCARE-CARD) -. / Hamaguchi, Sanae; Kinugawa, Shintaro; Tsuchihashi-Makaya, Miyuki; Goto, Daisuke; Yamada, Satoshi; Yokoshiki, Hisashi; Takeshita, Akira; Tsutsui, Hiroyuki.

In: Circulation Journal, Vol. 76, No. 8, 02.08.2012, p. 1920-1927.

Research output: Contribution to journalArticle

Hamaguchi, Sanae ; Kinugawa, Shintaro ; Tsuchihashi-Makaya, Miyuki ; Goto, Daisuke ; Yamada, Satoshi ; Yokoshiki, Hisashi ; Takeshita, Akira ; Tsutsui, Hiroyuki. / Loop diuretic use at discharge is associated with adverse outcomes in hospitalized patients with heart failure - A report from the Japanese cardiac registry of heart failure in cardiology (JCARE-CARD) -. In: Circulation Journal. 2012 ; Vol. 76, No. 8. pp. 1920-1927.
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abstract = "Background: Loop diuretics are commonly used in patients with heart failure (HF) to remove retained fluid and improve symptoms. However, they may potentially worsen outcomes in HF. It remains unknown whether the use of loop diuretics is associated with adverse HF outcomes in routine clinical practice. We thus determined the effects of loop diuretic use at discharge on long-term mortality and rehospitalization among patients hospitalized with HF. Methods and Results: The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) prospectively studied the characteristics and treatments of a broad sample of patients hospitalized with worsening HF and followed for 2.1 years. Among a total of 2,549 HF patients, loop diuretics were used by 2,015 patients (79{\%}), but not 534 patients (21{\%}). The mean age was 70.7 years and 60{\%} were male. Etiology was ischemic in 32{\%} and mean left ventricular ejection fraction was 42{\%}. After adjustment for covariates, discharge use of loop diuretics was associated with significant adverse risks of cardiac death (adjusted hazard ratio [HR] 2.348, 95{\%} confidence interval [CI] 1.246-4.423, P=0.008) and rehospitalization (adjusted HR 1.427, 95{\%} CI 1.040-1.959, P=0.027). Conclusions: Among patients hospitalized with worsening HF, loop diuretic use at discharge was associated with long-term adverse outcomes, which suggests that routine chronic use of loop diuretics may be harmful for patients with HF.",
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AU - Kinugawa, Shintaro

AU - Tsuchihashi-Makaya, Miyuki

AU - Goto, Daisuke

AU - Yamada, Satoshi

AU - Yokoshiki, Hisashi

AU - Takeshita, Akira

AU - Tsutsui, Hiroyuki

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N2 - Background: Loop diuretics are commonly used in patients with heart failure (HF) to remove retained fluid and improve symptoms. However, they may potentially worsen outcomes in HF. It remains unknown whether the use of loop diuretics is associated with adverse HF outcomes in routine clinical practice. We thus determined the effects of loop diuretic use at discharge on long-term mortality and rehospitalization among patients hospitalized with HF. Methods and Results: The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) prospectively studied the characteristics and treatments of a broad sample of patients hospitalized with worsening HF and followed for 2.1 years. Among a total of 2,549 HF patients, loop diuretics were used by 2,015 patients (79%), but not 534 patients (21%). The mean age was 70.7 years and 60% were male. Etiology was ischemic in 32% and mean left ventricular ejection fraction was 42%. After adjustment for covariates, discharge use of loop diuretics was associated with significant adverse risks of cardiac death (adjusted hazard ratio [HR] 2.348, 95% confidence interval [CI] 1.246-4.423, P=0.008) and rehospitalization (adjusted HR 1.427, 95% CI 1.040-1.959, P=0.027). Conclusions: Among patients hospitalized with worsening HF, loop diuretic use at discharge was associated with long-term adverse outcomes, which suggests that routine chronic use of loop diuretics may be harmful for patients with HF.

AB - Background: Loop diuretics are commonly used in patients with heart failure (HF) to remove retained fluid and improve symptoms. However, they may potentially worsen outcomes in HF. It remains unknown whether the use of loop diuretics is associated with adverse HF outcomes in routine clinical practice. We thus determined the effects of loop diuretic use at discharge on long-term mortality and rehospitalization among patients hospitalized with HF. Methods and Results: The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) prospectively studied the characteristics and treatments of a broad sample of patients hospitalized with worsening HF and followed for 2.1 years. Among a total of 2,549 HF patients, loop diuretics were used by 2,015 patients (79%), but not 534 patients (21%). The mean age was 70.7 years and 60% were male. Etiology was ischemic in 32% and mean left ventricular ejection fraction was 42%. After adjustment for covariates, discharge use of loop diuretics was associated with significant adverse risks of cardiac death (adjusted hazard ratio [HR] 2.348, 95% confidence interval [CI] 1.246-4.423, P=0.008) and rehospitalization (adjusted HR 1.427, 95% CI 1.040-1.959, P=0.027). Conclusions: Among patients hospitalized with worsening HF, loop diuretic use at discharge was associated with long-term adverse outcomes, which suggests that routine chronic use of loop diuretics may be harmful for patients with HF.

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