CLINICAL RESEARCH: HEART FAILURE
Diuretic use, progressive heart failure, and death in patients in the studies of left ventricular dysfunction (SOLVD)
Michael Domanski, MD*,*,
James Norman, PhD*,
Bertram Pitt, MD ,
Mark Haigney, MD ,
Stephen Hanlon, MD and
Eliot Peyster*
* Clinical Trials Group, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
Department of Cardiology, University of Michigan Medical Center, Ann Arbor, Michigan, USA
National Naval Center Medical Center, Bethesda, Maryland, USA
Manuscript received October 16, 2002;
revised manuscript received March 19, 2003,
accepted March 27, 2003.
* Reprint requests and correspondence: Dr. Michael Domanski, National Heart, Lung, and Blood Institute, 6701 Rocklege Avenue, Bethesda, Maryland 20892-7936, USA.
domanskm{at}NIH.gov
OBJECTIVES: We sought to determine whether non–potassium-sparing diuretics (PSDs) in the absence of a PSD may result in progressive heart failure (HF).
BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors incompletely suppress ACE activity in HF patients. Furthermore, non-PSDs are activators of aldosterone secretion. We reasoned that non-PSDs, in the absence of a PSD, might result in progressive HF.
METHODS: In the 6,797 patients in the Studies Of Left Ventricular Dysfunction (SOLVD), we compared the risk of hospitalization for, or death from, HF between those taking a PSD and those who were not, adjusting for known covariates.
RESULTS: The risk of hospitalization from worsening HF in those taking a PSD relative to those taking only a non-PSD was 0.74 (95% confidence interval [CI] 0.55 to 0.99; p = 0.047). The relative risk for cardiovascular death was 0.74 (95% CI 0.59 to 0.93; p = 0.011), for death from all causes 0.73 (95% CI 0.59 to 0.90; p = 0.004), and for hospitalization for, or death from, HF 0.75 (95% CI 0.58 to 0.97; p = 0.030). Compared with patients not taking any diuretic, the risk of hospitalization or death due to worsening HF in patients taking non-PSDs alone was significantly increased (risk ratio [RR] = 1.31, 95% CI 1.09 to 1.57; p = 0.0004); this was not observed in patients taking PSDs with or without a non-PSD (RR = 0.99, 95% CI 0.76 to 1.30; p = 0.95).
CONCLUSIONS: The use of PSDs in HF patients is associated with a reduced risk of death from, or hospitalization for, progressive HF or all-cause or cardiovascular death, compared with patients taking only a non-PSD.
|
Abbreviations and Acronyms
| | ACE | | angiotensin-converting enzyme | | CI | | confidence interval | | HF | | heart failure | | PSD | | potassium-sparing diuretic | | RALES | | Randomized ALdactone Evaluation Study | | RR | | risk ratio | | SOLVD | | Studies Of Left Ventricular Dysfunction |
|
This article has been cited by other articles:
|
|
|
|
 
Authors/Task Force Members, D. Poldermans, J. J. Bax, E. Boersma, S. De Hert, E. Eeckhout, G. Fowkes, B. Gorenek, M. G. Hennerici, B. Iung, et al.
Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery: The Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA)
Eur. Heart J.,
November 2, 2009;
30(22):
2769 - 2812.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. A. Bart
Treatment of Congestion in Congestive Heart Failure: Ultrafiltration Is the Only Rational Initial Treatment of Volume Overload in Decompensated Heart Failure
Circ Heart Fail,
September 1, 2009;
2(5):
499 - 504.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. E.A. Blair, S. Khan, M. A. Konstam, K. Swedberg, F. Zannad, J. C. Burnett Jr, L. Grinfeld, A. P. Maggioni, J. E. Udelson, C. A. Zimmer, et al.
Weight changes after hospitalization for worsening heart failure and subsequent re-hospitalization and mortality in the EVEREST trial
Eur. Heart J.,
July 1, 2009;
30(13):
1666 - 1673.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, D. M. Mancini, K. Michl, et al.
2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation
J. Am. Coll. Cardiol.,
April 14, 2009;
53(15):
e1 - e90.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Jessup, W. T. Abraham, D. E. Casey, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. A. Konstam, D. M. Mancini, P. S. Rahko, M. A. Silver, et al.
2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation
J. Am. Coll. Cardiol.,
April 14, 2009;
53(15):
1343 - 1382.
[Full Text]
[PDF]
|
|
|
|
|
|
|
2009 WRITING GROUP TO REVIEW NEW EVIDENCE AND UPDA, M. Jessup, W. T. Abraham, D. E. Casey, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. A. Konstam, D. M. Mancini, P. S. Rahko, et al.
2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation
Circulation,
April 14, 2009;
119(14):
1977 - 2016.
[Full Text]
[PDF]
|
|
|
|
|
|
|
2005 WRITING COMMITTEE MEMBERS, S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, D. M. Mancini, et al.
2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation
Circulation,
April 14, 2009;
119(14):
e391 - e479.
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. C. Levy, D. Mozaffarian, D. T. Linker, K. W. Kenyon, J. G.F. Cleland, M. Komajda, W. J. Remme, C. Torp-Pedersen, M. Metra, P. A. Poole-Wilson, et al.
Years-needed-to-treat to add 1 year of life: a new metric to estimate treatment effects in randomized trials
Eur J Heart Fail,
March 1, 2009;
11(3):
256 - 263.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Gheorghiade and P. S. Pang
Acute heart failure syndromes.
J. Am. Coll. Cardiol.,
February 17, 2009;
53(7):
557 - 573.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. A. Schweiger and M. M. Zdanowicz
Vasopressin-receptor antagonists in heart failure
Am. J. Health Syst. Pharm.,
May 1, 2008;
65(9):
807 - 817.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. T. Koller, B. Schaer, M. Wolbers, C. Sticherling, H. C. Bucher, and S. Osswald
Death Without Prior Appropriate Implantable Cardioverter-Defibrillator Therapy: A Competing Risk Study
Circulation,
April 15, 2008;
117(15):
1918 - 1926.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Kazory and E. A. Ross
Contemporary Trends in the Pharmacological and Extracorporeal Management of Heart Failure: A Nephrologic Perspective
Circulation,
February 19, 2008;
117(7):
975 - 983.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members:, G. Mancia, G. De Backer, A. Dominiczak, R. Cifkova, R. Fagard, G. Germano, G. Grassi, A. M. Heagerty, S. E. Kjeldsen, et al.
2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)
Eur. Heart J.,
June 11, 2007;
(2007)
ehm236v1.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Ahmed, F. Zannad, T. E. Love, J. Tallaj, M. Gheorghiade, O. J. Ekundayo, and B. Pitt
A propensity-matched study of the association of low serum potassium levels and mortality in chronic heart failure
Eur. Heart J.,
June 1, 2007;
28(11):
1334 - 1343.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Lindenfeld and F. A. Masoudi
Fluid Retention With Thiazolidinediones: Does the Mechanism Influence the Outcome?
J. Am. Coll. Cardiol.,
April 24, 2007;
49(16):
1705 - 1707.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Konstam, M. Gheorghiade, J. C. Burnett Jr, L. Grinfeld, A. P. Maggioni, K. Swedberg, J. E. Udelson, F. Zannad, T. Cook, J. Ouyang, et al.
Effects of Oral Tolvaptan in Patients Hospitalized for Worsening Heart Failure: The EVEREST Outcome Trial
JAMA,
March 28, 2007;
297(12):
1319 - 1331.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. W. Yancy
Climbing the Mountain of Acute Decompensated Heart Failure: The EVEREST Trials
JAMA,
March 28, 2007;
297(12):
1374 - 1376.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. A. Allen and C. M. O'Connor
Management of acute decompensated heart failure
Can. Med. Assoc. J.,
March 13, 2007;
176(6):
797 - 805.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. R. Costanzo, M. E. Guglin, M. T. Saltzberg, M. L. Jessup, B. A. Bart, J. R. Teerlink, B. E. Jaski, J. C. Fang, E. D. Feller, G. J. Haas, et al.
Ultrafiltration Versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Heart Failure
J. Am. Coll. Cardiol.,
February 13, 2007;
49(6):
675 - 683.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. M. deGoma, R. H. Vagelos, M. B. Fowler, and E. A. Ashley
Emerging Therapies for the Management of Decompensated Heart Failure: From Bench to Bedside
J. Am. Coll. Cardiol.,
December 19, 2006;
48(12):
2397 - 2409.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Groban and J. Butterworth
Perioperative management of chronic heart failure.
Anesth. Analg.,
September 1, 2006;
103(3):
557 - 575.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Ahmed, A. Husain, T. E. Love, G. Gambassi, L. J. Dell'Italia, G. S. Francis, M. Gheorghiade, R. M. Allman, S. Meleth, and R. C. Bourge
Heart failure, chronic diuretic use, and increase in mortality and hospitalization: an observational study using propensity score methods
Eur. Heart J.,
June 2, 2006;
27(12):
1431 - 1439.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Gheorghiade, D. J. van Veldhuisen, and W. S. Colucci
Contemporary Use of Digoxin in the Management of Cardiovascular Disorders
Circulation,
May 30, 2006;
113(21):
2556 - 2564.
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. C. Levy, D. Mozaffarian, D. T. Linker, S. C. Sutradhar, S. D. Anker, A. B. Cropp, I. Anand, A. Maggioni, P. Burton, M. D. Sullivan, et al.
The Seattle Heart Failure Model: Prediction of Survival in Heart Failure
Circulation,
March 21, 2006;
113(11):
1424 - 1433.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. C. Costello-Boerrigter, W. B. Smith, G. Boerrigter, J. Ouyang, C. A. Zimmer, C. Orlandi, and J. C. Burnett Jr.
Vasopressin-2-receptor antagonism augments water excretion without changes in renal hemodynamics or sodium and potassium excretion in human heart failure
Am J Physiol Renal Physiol,
February 1, 2006;
290(2):
F273 - F278.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Ahmed, M. W. Rich, T. E. Love, D. M. Lloyd-Jones, I. B. Aban, W. S. Colucci, K. F. Adams, and M. Gheorghiade
Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG trial
Eur. Heart J.,
January 2, 2006;
27(2):
178 - 186.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Vidal, Y. Sun, S. K. Bhattacharya, R. A. Ahokas, I. C. Gerling, and K. T. Weber
Calcium paradox of aldosteronism and the role of the parathyroid glands
Am J Physiol Heart Circ Physiol,
January 1, 2006;
290(1):
H286 - H294.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. A. Bart, A. Boyle, A. J. Bank, I. Anand, M. T. Olivari, M. Kraemer, S. Mackedanz, P. A. Sobotka, M. Schollmeyer, and S. R. Goldsmith
Ultrafiltration Versus Usual Care for Hospitalized Patients With Heart Failure: The Relief for Acutely Fluid-Overloaded Patients With Decompensated Congestive Heart Failure (RAPID-CHF) Trial
J. Am. Coll. Cardiol.,
December 6, 2005;
46(11):
2043 - 2046.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. R. Costanzo, M. Saltzberg, J. O'Sullivan, and P. Sobotka
Early Ultrafiltration in Patients With Decompensated Heart Failure and Diuretic Resistance
J. Am. Coll. Cardiol.,
December 6, 2005;
46(11):
2047 - 2051.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. D. White, P. E.G. Aylward, Z. Huang, A. J. Dalby, W. D. Weaver, S. Barvik, J. A. Marin-Neto, J. Murin, R. O. Nordlander, W. H. van Gilst, et al.
Mortality and Morbidity Remain High Despite Captopril and/or Valsartan Therapy in Elderly Patients With Left Ventricular Systolic Dysfunction, Heart Failure, or Both After Acute Myocardial Infarction: Results From the Valsartan in Acute Myocardial Infarction Trial (VALIANT)
Circulation,
November 29, 2005;
112(22):
3391 - 3399.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. R. Goldsmith and M. Gheorghiade
Vasopressin Antagonism in Heart Failure
J. Am. Coll. Cardiol.,
November 15, 2005;
46(10):
1785 - 1791.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Konstam, B. Czerska, M. Bohm, R. M. Oren, J. Sadowski, S. Khanal, W. T. Abraham, A. Wasler, J. B. Dahm, A. Gavazzi, et al.
Continuous Aortic Flow Augmentation: A Pilot Study of Hemodynamic and Renal Responses to a Novel Percutaneous Intervention in Decompensated Heart Failure
Circulation,
November 15, 2005;
112(20):
3107 - 3114.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Yoshida, K. Yamamoto, T. Mano, Y. Sakata, M. Nishio, T. Ohtani, M. Hori, T. Miwa, and T. Masuyama
Different effects of long- and short-acting loop diuretics on survival rate in Dahl high-salt heart failure model rats
Cardiovasc Res,
October 1, 2005;
68(1):
118 - 127.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. H. Law, Y. Sun, S. K. Bhattacharya, V. S. Chhokar, and K. T. Weber
Diuretics and Bone Loss in Rats With Aldosteronism
J. Am. Coll. Cardiol.,
July 5, 2005;
46(1):
142 - 146.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. T. Yan, R. T. Yan, and P. P. Liu
Narrative Review: Pharmacotherapy for Chronic Heart Failure: Evidence from Recent Clinical Trials
Ann Intern Med,
January 18, 2005;
142(2):
132 - 145.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. McCurley, S. U. Hanlon, S.-k. Wei, E. F. Wedam, M. Michalski, and M. C. Haigney
Furosemide and the progression of left ventricular dysfunction in experimental heart failure
J. Am. Coll. Cardiol.,
September 15, 2004;
44(6):
1301 - 1307.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. T. Weber
Furosemide in the long-term management of heart failure: The good, the bad, and the uncertain
J. Am. Coll. Cardiol.,
September 15, 2004;
44(6):
1308 - 1310.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Bundgaard
Potassium depletion improves myocardial potassium uptake in vivo
Am J Physiol Cell Physiol,
July 1, 2004;
287(1):
C135 - C141.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Gheorghiade, W. A. Gattis, C. M. O'Connor, K. F. Adams Jr, U. Elkayam, A. Barbagelata, J. K. Ghali, R. L. Benza, F. A. McGrew, M. Klapholz, et al.
Effects of Tolvaptan, a Vasopressin Antagonist, in Patients Hospitalized With Worsening Heart Failure: A Randomized Controlled Trial
JAMA,
April 28, 2004;
291(16):
1963 - 1971.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
