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

• Published in: European journal of internal medicine Vol. 127; pp. 126 - 133
• Main Authors: Miró, Òscar, Núñez, Julio, Lopez-Ayala, Pedro, Llauger, Lluís, Miñana, Gema, Mollar, Anna, Jacob, Javier, Aguirre, Alfons, Gil, Víctor, Mueller, Christian, Llorens, Pere, Davila, Aitor, Martín-Sánchez, Francisco Javier, Escoda, Rosa, Masso, Marta, Millán, Javier, Serrano, Leticia, Pavón, José, Reyes, Juan Antonio Vega, López-Grima, María Luisa, Valero, Amparo, Masó, Silvia Mínguez, Mecina, Ana Belén, Tost, Josep, Ramón, Susana Sánchez, Rodríguez, Virginia Carbajosa, Piñera, Pascual, Nicolás, José Andrés Sánchez, Garate, Raquel Torres, Alquézar-Arbé, Aitor, Herrera, Sergio, Roset, Alex, Cabello, Irene, Richard, Fernando, Fernández, Elisa, Puente, Pablo Herrero, García, Belén Prieto, Fernández, Alejandra Fernández, Ramos, Belén Álvarez, Jara, Gema, López, Mariella Luengo, Domínguez, Gema, Ruíz, Martín, Arriaga, Beatriz Amores, Bergua, Beatriz Sierra, Bécquer, Lisette Travería, García, Lluís Llauger, Urbano, Carmen Agüera, de los Ángeles, María, de la Torre, González, Jiménez, Carmen Esmeralda Romero, Ferrer, Ester Soy, Múñoz, María Adroher, Gaya, Rut, Mir, María, Rodríguez, Beatriz, Adrada, Esther Rodríguez, Domingo, Eva, Carvajal, Marianela Guzmán, García, Yelenis Gómez, García, Rocío Moyano, Rodríguez, Pablo, Blasco, Santiago Harris, Romero, Marta, Lorenzo, Miguel, Núñez, Gonzalo, de la Espriella, Rafael, Villar, Sandra, Santas, Enrique, Sanchis, Juan, Bautista, Prado Salamanca, Olmedo, Jesús, Vázquez, Carmen, López, Juan Bosco, Peinado, Alejandro, Montes, Juan Antonio, Díez-Manglano, Jesús, Rodés, Pablo Martínez, Martel, Alicia Conde, González, Sonia, Hernández, Rubén, Gudiño, Diego José, Mendoza, Humberto, Carrera, Margarita, Trullàs, Joan Carles, Biosca, Anna Sánchez, Massi, Paulina Ivanova, Núñez, Raquel, Ceresuela, Luis, Morales, José Luís, Pla, Xavi, López, Gabriel, Reboiro, Manuel Lorenzo López, Llàcer, Pau, Ortega, Raúl Antonio Ruiz, Soler, Llanos, Mesado, Daniel, Ballesta, Ana Isabel Peláez, Rodríguez, Elena Morcillo
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-09-2024
• Subjects: Acute heart failure; Aged; Aged, 80 and over; Diuretics; Drug Therapy, Combination; Female; Heart Failure - drug therapy; Heart Failure - mortality; Hospitalization - statistics & numerical data; Humans; Loop diuretics; Male; Mortality; Outcome; Patient Discharge; Proportional Hazards Models; Sodium Chloride Symporter Inhibitors - administration & dosage; Sodium Chloride Symporter Inhibitors - therapeutic use; Sodium Potassium Chloride Symporter Inhibitors - administration & dosage; Sodium Potassium Chloride Symporter Inhibitors - adverse effects; Sodium Potassium Chloride Symporter Inhibitors - therapeutic use; Thiazides; Treatment Outcome; Diuretics; Loop diuretics; Thiazides; Outcome; Mortality; Acute heart failure
• ISSN: 0953-6205; 1879-0828; 1879-0828
• DOI: 10.1016/j.ejim.2024.05.009

•In patients with acute heart failure, it is recommended to add a second diuretic early if the patient has not responded adequately to the initial diuretic.•The combination of thiazide and loop diuretics at discharge was not associated with a risk of adverse clinical events.•The effect of a nephron blockade strategy using in the outpatient setting after a recent episode of AHF is sure.
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.
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.
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).
The combination of thiazide and loop diuretics was not associated with changes in risk of death, hospitalization or a combination of both.