Association of loop diuretics use and dose with outcomes in outpatients with heart failure: a systematic review and meta-analysis of observational studies involving 96,959 patients

AbstractThere is ongoing controversy regarding the association between loop diuretics (LD), especially in high doses, and adverse clinical outcomes in outpatients with heart failure (HF). We performed a systematic review of the evidence for LD in outpatients with HF. We searched MEDLINE, EMBASE, and Cochrane Clinical Trial Collection to identify controlled studies, evaluating the association between LD and morbidity and mortality in patients with HF. The primary endpoint was all-cause mortality and secondary endpoint  HF hospitalizations. Quantitative analysis was performed by generating forest plots and pooling adjusted risk estimates across studies using random effects models. Between-study heterogeneity was assessed throughQ andI2 statistics. Twenty-four studies with a total of 96,959 patients were included. No randomized studies were identified. Use of LD was associated with increased all-cause mortality compared with non-use (pooledadjusted risk estimates, 1.18;P = 0.001) and increased HF hospitalization rates (pooledadjusted risk estimates, 1.81;P <  0.001). These associations remained significant after excluding studies that included HF patients at discharge from hospital (pooledadjusted risk estimates, 1.31 and 1.89, respectively;P <  0.001 for both). High-dose LD (median dose 80 mg) were also associated with increased all-cause mortality (pooledadjusted risk estimates, 1.99;P <  0.001) compared with low-dose LD. Again, this association rema...
Source: Heart Failure Reviews - Category: Cardiology Source Type: research