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

Session Poster Session 3

Speaker Associate Professor Lutz Frankenstein

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Pharmacotherapy
  • Session type : Poster Session

Authors : L Frankenstein (Heidelberg,DE), H Froehlich (Heidelberg,DE), M Grundtvig (Lillehammer,NO), M Seiz (Heidelberg,DE), D Schellberg (Heidelberg,DE), K Goode (Cottingham,GB), S Kazmi (Cottingham,GB), T Hole (Trondheim,NO), HA Katus (Heidelberg,DE), D Atar (Oslo,NO), JGF Cleland (London,GB), S Agewall (Oslo,NO), AL Clark (Cottingham,GB), L Frankenstein (Heidelberg,DE)

L Frankenstein1 , H Froehlich1 , M Grundtvig2 , M Seiz1 , D Schellberg1 , K Goode3 , S Kazmi3 , T Hole4 , HA Katus1 , D Atar5 , JGF Cleland6 , S Agewall5 , AL Clark3 , L Frankenstein1 , 1The Medical Faculty of Heidelberg - Heidelberg - Germany , 2Innlandet Hospital - Lillehammer - Norway , 3Castle Hill Hospital - Cottingham - United Kingdom of Great Britain & Northern Ireland , 4Norwegian University of Science and Technology - Trondheim - Norway , 5University of Oslo - Oslo - Norway , 6Imperial College London, National Heart & Lung Institute - London - United Kingdom of Great Britain & Northern Ireland ,


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: 6,293 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 either drug and dose-equivalents thereof.

Results: During a follow-up of 35,038 patient-years, 652 (53.7%), 2,179 (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, after adjustment for potential prescribing-biases, mortality does not appear to be affected by choice of loop diuretic in clinical practice. The results of randomised trials comparing diuretic agents are awaited.

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