Prognostic impact of loop diuretics in patients with chronic heart failure – Effects of addition of renin-angiotensin-aldosterone system inhibitors and β-blockers

CHART-2 investigators

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)

Abstract

Background:It remains to be elucidated whether addition of renin-angiotensin-aldosterone system (RAAS) inhibitors and/or β-blockers to loop diuretics has a beneficial prognostic impact on chronic heart failure (CHF) patients.Methods and Results:From the Chronic Heart failure Analysis and Registry in the Tohoku district 2 (CHART-2) Study (n=10,219), we enrolled 4,134 consecutive patients with symptomatic stage C/D CHF (mean age, 69.3 years, 67.7% male). We constructed Cox models for composite of death, myocardial infarction, stroke and HF admission. On multivariate inverse probability of treatment weighted (IPTW) Cox modeling, loop diuretics use was associated with worse prognosis with hazard ratio (HR) 1.28 (P<0001). Furthermore, on IPTW multivariate Cox modeling for multiple treatments, both low-dose (<40 mg/day) and high-dose (≥40 mg/day) loop diuretics were associated with worse prognosis with HR 1.32 and 1.56, respectively (both P<0.001). Triple blockade with RAS inhibitor(s), mineral corticoid (aldosterone) receptor antagonist(s) (MRA), and β-blocker(s) was significantly associated with better prognosis in those on low-dose but not on high-dose loop diuretics.Conclusions:Chronic use of loop diuretics is significantly associated with worse prognosis in CHF patients in a dose-dependent manner, whereas the triple combination of RAAS inhibitor(s), MRA, and β-blocker(s) is associated with better prognosis when combined with low-dose loop diuretics.

Original languageEnglish
Pages (from-to)1396-1403
Number of pages8
JournalCirculation Journal
Volume80
Issue number6
DOIs
Publication statusPublished - 2016

Keywords

  • Chronic heart failure
  • Loop diuretics
  • Prognosis
  • Treatment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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