Comparative effectiveness of loop diuretics on mortality in the treatment of patients with chronic heart failure – a multicenter propensity score matched analysis

Täger, T. et al. (2019) Comparative effectiveness of loop diuretics on mortality in the treatment of patients with chronic heart failure – a multicenter propensity score matched analysis. International Journal of Cardiology, 289, pp. 83-90. (doi:10.1016/j.ijcard.2019.01.109) (PMID:30827731)

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Abstract

Background: Loop diuretics are given to the majority of patients with chronic heart failure (HF). Whether the different pharmacological properties of the three guideline-recommended loop diuretics result in differential effects on survival is unknown. Methods: 6293 patients with chronic HF using either bumetanide, furosemide or torasemide were identified in three European HF registries. Patients were individually matched on both the respective propensity scores for receipt of the individual drug and dose-equivalents thereof. Results: During a follow-up of 35,038 patient-years, 652 (53.7%), 2179 (51.9%), and 268 (30.4%) patients died amongst those prescribed bumetanide, furosemide, and torasemide, respectively. In univariable analyses of the general sample, bumetanide and furosemide were both associated with higher mortality as compared with torasemide treatment (HR 1.50, 95% CI 1.31–1.73, p < 0.001, and HR 1.34, CI 1.18–1.52, p < 0.001, respectively). Mortality was higher in bumetanide users when compared to furosemide users (HR 1.11, 95% CI 1.02–1.20, p = 0.01). However, there was no significant association between loop diuretic choice and all-cause mortality in any of the matched samples (bumetanide vs. furosemide, HR 1.03, 95% CI 0.93–1.14, p = 0.53; bumetanide vs. torasemide, HR 0.98, 95% CI 0.78–1.24, p = 0.89; furosemide vs. torasemide, HR 1.02, 95% CI 0.84–1.24, p = 0.82). The results were confirmed in subgroup analyses with respect to age, sex, left ventricular ejection fraction, NYHA functional class, cause of HF, rhythm, and systolic blood pressure. Conclusions: In patients with HF, mortality is not affected by the choice of individual loop diuretics.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John
Authors: Täger, T., Fröhlich, H., Grundtvig, M., Seiz, M., Schellberg, D., Goode, K., Kazmi, S., Hole, T., Katus, H. A., Atar, D., Cleland, J. G.F., Agewall, S., Clark, A. L., and Frankenstein, L.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:International Journal of Cardiology
Publisher:Elsevier
ISSN:0167-5273
ISSN (Online):1874-1754
Published Online:02 February 2019
Copyright Holders:Copyright © 2019 Elsevier B.V.
First Published:First published in International Journal of Cardiology 289: 83-90
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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