A propensity-matched study of the effects of chronic diuretic therapy on mortality and hospitalization in older adults with heart failure

Background: Non-potassium-sparing diuretics may increase mortality and hospitalizations in heart failure patients. Most heart failure patients are older adults, yet the effect of diuretics on cause-specificmortality and hospitalizations in older adults with heart failure is unknown. The objective of this propensity-matched study was to determine the effect of diuretics on mortality and hospitalizations in heart failure patients >= 65 years. Methods: Of the 7788 Digitalis Investigation Group participants, 4036 were >= 65 years and 3271 (81%) were receiving diuretics. Propensity scores for diuretic use for each of the 4036 patients were calculated using a non-parsimonious multivariable logistic regression model incorporating all measured baseline covariates, and were used to match 651 (85%) patients not receiving diuretics with 651 patients receiving diuretics. Effects of diuretics on mortality and hospitalization at 37 months of median follow-up were assessed using matched Cox regression models. Results: All-cause mortality occurred in 173 patients not receiving diuretics and 208 patients receiving diuretics respectively during 2056 and 1943 person-years of follow-up (hazard ratio {HR}= 1.36; 95% confidence interval {CI}= 1.08-1.71; p= 0.009). All-cause hospitalizations occurred in 413 patients not receiving and 438 patients receiving diuretics respectively during 1255 and 1144 person-years of follow-up (HR = 1.18; 95% CI = 0.99-1.39; p= 0.063). Diuretic use was associated with significant increased risk of cardiovascular mortality (HR = 1.50; 95% CI = 1.15-1.96; p = 0.003). and heart failure hospitalization (HR = 1.48; 95% CI = 1.13-1.94; p= 0.005). Conclusions: Chronic diuretic use was associated with significant increased mortality and hospitalization in ambulatory older adults with heart failure receiving angiotensin converting enzyme inhibitor and diuretics. (C) 2007 Elsevier Ireland Ltd. All rights reserved.