Decrease in loop diuretic treatment from 2005 to 2014 in Swedish real-life patients with chronic heart failure

Abstract

PurposeLoop diuretics are recommended to treat congestive symptoms in patients with heart failure. However, observational studies have indicated that loop diuretic treatment in heart failure is associated with increased mortality. Therefore, loop diuretic discontinuation or dose reduction, when clinically possible, is recommended. Our aim was to study nationwide temporal trends in loop diuretic treatment from 2005 to 2014 in real-life patients with chronic heart failure.MethodsData from the nationwide Swedish National Patient, Prescribed Drug and Cause of Death Registers were linked. The annual proportions of patients with chronic heart failure treated with loop diuretics from 2005 to 2014 were calculated. In addition, the annual median loop diuretic doses (DDD) in patients with chronic heart failure treated with loop diuretics from 2005 to 2014 were calculated.ResultsThe proportion of real-life patients with chronic heart failure treated with loop diuretics decreased from 73.2% in 2005 to 65.7% in 2014 (p for trend < 0.001). The median loop diuretic DDD in real-life patients with chronic heart failure decreased from 2.13 (IQR 1.09–2.77) in 2005 to 1.63 (IQR 1.09–2.25) in 2014 (p = 0.001 for trend).ConclusionsLoop diuretic treatment decreased from 2005 to 2014 in real-life patients with chronic heart failure. The prognostic impact of changes in loop diuretic treatment in patients with heart failure remains unclear.Electronic supplementary materialThe online version of this article (10.1007/s00228-018-2574-6) contains supplementary material, which is available to authorized users.

Temporal trends of a vasopressin V2 receptor antagonist in heart failure using a nationwide database in Japan

“…Several observational studies have reported that high‐dose loop diuretics are associated with poor prognoses in patients with HF 18–21 . A recent Swedish nationwide cohort study reported a trend of decreased prescription rates and dose of loop diuretics for the patients with chronic HF 22 . The SMILE study demonstrated that the baseline dose of oral diuretics decreased from 69.3 to 54.9 mg between 2011 and 2015 11 .…”

“…[18][19][20][21] A recent Swedish nationwide cohort study reported a trend of decreased prescription rates and dose of loop diuretics for the patients with chronic HF. 22 The SMILE study demonstrated that the baseline dose of oral diuretics decreased from 69.3 to 54.9 mg between 2011 and 2015. 11 Similarly, in our study, the baseline dose of oral loop diuretics (in furosemide equivalents) gradually decreased between Cohort 1 and Cohort 15.…”

Use of diuretics in shock: Temporal trends and clinical impacts in a propensity-matched cohort study

“…Also, it seems patients with higher body mass index receive diuretics more frequently [29]. Interestingly, based on a large scale study, patients with chronic heart failure who depend on the maintenance of their volume balance for a better quality of life used a lower amount of loop diuretics [30]. The information regarding the temporal trends of diuretic utilization among patients which septic shock is scarce.…”

Cardiovascular drug use among people with cognitive impairment living in nursing homes in northern Sweden

“…Using prescription data alone has been suggested as a method to identify people with heart failure, although the specificity and sensitivity are lower compared to ICD codes [34]. Another drawback is a potential change in sensitivity/specificity of the proxy between 2007 and 2013, as a result of the decreased use of loop diuretics among people with heart failure over the years [60]. Furthermore, the reasons for drug prescription were not recorded in this study, and the doses of the drugs were not registered.…”