Use of diuretics and outcomes in patients with type 2 diabetes: findings from the EMPA-REG OUTCOME trial

Pellicori, P. et al. (2021) Use of diuretics and outcomes in patients with type 2 diabetes: findings from the EMPA-REG OUTCOME trial. European Journal of Heart Failure, 23(7), pp. 1085-1093. (doi: 10.1002/ejhf.2220) (PMID:34031968)

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Background: Loop diuretics (LD) relieve symptoms and signs of congestion due to heart failure (HF), but many patients prescribed LD do not have such a diagnosis. Aims and methods: We studied the relationship between HF diagnosis, use of LD, and outcomes in four patient subgroups with type-2 diabetes mellitus (T2DM) in EMPA-REG OUTCOME; [i) investigator-reported HF on LD, ii) investigator-reported HF not on LD, iii] no HF on LD, and iv) no HF and not on LD], and assessed their risk of CV events. Results: Of 7,020 participants, at baseline, 706 (10%) had a diagnosis of HF, of whom 334 were prescribed LD. However, 755 (11%) patients who did not have a diagnosis of HF were prescribed LD. Compared to those with neither HF nor prescribed LD (reference group; placebo), those with both HF and receiving LD had the highest rates for all-cause (hazard ratio [HR] [95% CI]: 3.19 [2.03-5.01]) and CV mortality (3.83 [2.28-6.44]), and HF hospitalisations (HHF) (9.51 [5.61-16.14]). Patients without HF but prescribed LD had higher rates for all three outcomes (1.62 [1.10-2.39]); 1.97 [1.26-3.08]); 3.20 [1.90-5.39]), which were similar to patients with HF who were not receiving LD (1.42 [0.78-2.57]; 1.56 [0.78-3.11]; 3.00 [1.40-6.40)]). Empagliflozin had similar benefits regardless of subgroup (p for interaction >0.1 for all outcomes). Conclusion: Patients with T2DM prescribed LD are at greater risk of CV events even if they are not reported to have HF; this might reflect under-diagnosis. Empagliflozin was similarly effective in all subgroups investigated.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Cleland, Professor John and Pellicori, Dr Pierpaolo
Authors: Pellicori, P., Fitchett, D., Kosiborod, M. N., Ofstad, A. P., Seman, L., Zinman, B., Zwiener, I., Wanner, C., George, J., Inzucchi, S. E., Testani, J. M., and Cleland, J. G.F.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
Journal Name:European Journal of Heart Failure
ISSN (Online):1879-0844
Published Online:24 May 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in European Journal of Heart Failure 23(7): 1085-1093
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science