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Combining loop with thiazide diuretics in patients discharged home after a heart failure decompensation: association with 30-day outcomes

Abstract: Objective: To investigate the association of the addition of thiazide diuretic on top of loop diuretic and standard of care with short-term outcomes of patients discharged after surviving an acute heart failure (AHF) episode. Methods: This is a secondary analysis of 14,403 patients from three independent cohorts representing the main departments involved in AHF treatment for whom treatment at discharge was recorded and included loop diuretics. Patients were divided according to whether treatment included or not thiazide diuretics. Short-term outcomes consisted of 30-day all-cause mortality, hospitalization (with a separate analysis for hospitalization due to AHF or to other causes) and the combination of death and hospitalization. The association between thiazide diuretics on short-term outcomes was explored by Cox regression and expressed as hazard ratios (HR) with 95 % confidence intervals, which were adjusted for 18 patient-related variables and 9 additional drugs (aside from loop and thiazide diuretics) prescribed at discharge. Results: The median age was 81 (interquartile range=73-86) years, 53 % were women, and patients were mainly discharged from the cardiology (42 %), internal medicine or geriatric department (29 %) and emergency department (19 %). There were 1,367 patients (9.5 %) discharged with thiazide and loop diuretics, while the rest (13,036; 90.5 %) were discharged with only loop diuretics on top of the remaining standard of care treatments. The combination of thiazide and loop diuretics showed a neutral effect on all outcomes: death (adjusted HR 1.149, 0.850-1.552), hospitalization (0.898, 0.770-1.048; hospitalization due to AHF 0.799, 0.599-1.065; hospitalization due to other causes 1.136, 0.756-1.708) and combined event (0.934, 0.811-1.076). Conclusion: The combination of thiazide and loop diuretics was not associated with changes in risk of death, hospitalization or a combination of both.

 Fuente: European Journal of Internal Medicine, 2024, 127, 126-133

 Publisher: Elsevier

 Year of publication: 2024

 No. of pages: 8

 Publication type: Article

 DOI: 10.1016/j.ejim.2024.05.009

 ISSN: 0953-6205,1879-0828

 Publication Url: https://doi.org/10.1016/j.ejim.2024.05.009

Authorship

MIRÓ, ÓSCAR

NÚÑEZ, JULIO

TRULLÀS, JOAN CARLES

LÓPEZ-AYALA, PEDRO

LLAUGER, LLUÍS

ALQUÉZAR-ARBÉ, AITOR

MIÑANA, GEMA

MOLLAR, ANNA

ESPRIELLA, RAFAEL DE LA

LORENZO, MIGUEL

JACOB, JAVIER

ESPINOSA, BEGOÑA

GARCÉS-HORNA, VANESA

AGUIERRE, ALFONS

FORTUNY, MARÍA JOSÉ

MARTÍNEZ-NADAL, GEMMA

GIL, VÍCTOR