This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cooper, H. A. Articles by Domanski, M. J. Search for Related Content PubMed PubMed Citation Articles by Cooper, H. A. Articles by Domanski, M. J. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Arrhythmia Hazardous Substances DB POTASSIUM Related Collections Arrhythmias, clinical electrophysiology, drugs Cardiovascular Pharmacology

(Circulation. 1999;100:1311-1315.)
© 1999 American Heart Association, Inc.

Clinical Investigation and Reports

Diuretics and Risk of Arrhythmic Death in Patients With Left Ventricular Dysfunction

Howard A. Cooper, MD; Daniel L. Dries, MD, MPH; C. E. Davis, PhD; Yuan Li Shen, DrPH; Michael J. Domanski, MD

From the Clinical Trials Scientific Research Group, Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (H.A.C., D.L.D., M.J.D.); the Division of Cardiology, Georgetown University Medical Center, Washington, DC (H.A.C., D.L.D.); and the Department of Biostatistics, University of North Carolina, Chapel Hill (C.E.D., Y.L.S.).

Correspondence to Howard A. Cooper, MD, Clinical Trials Scientific Research Group, National Heart, Lung, and Blood Institute, Two Rockledge Centre, Room 8149, 6701 Rockledge Dr, MSC 7936, Bethesda, MD 20892. E-mail Cooperh{at}nih.gov

Background—Treatment with diuretics has been reported to increase the risk of arrhythmic death in patients with hypertension. The effect of diuretic therapy on arrhythmic death in patients with left ventricular dysfunction is unknown.

Methods and Results—We conducted a retrospective analysis of 6797 patients with an ejection fraction <0.36 enrolled in the Studies Of Left Ventricular Dysfunction (SOLVD) to assess the relation between diuretic use at baseline and the subsequent risk of arrhythmic death. Participants receiving a diuretic at baseline were more likely to have an arrhythmic death than those not receiving a diuretic (3.1 vs 1.7 arrhythmic deaths per 100 person-years, P=0.001). On univariate analysis, diuretic use was associated with an increased risk of arrhythmic death (relative risk [RR] 1.85, P=0.0001). After controlling for important covariates, diuretic use remained significantly associated with an increased risk of arrhythmic death (RR 1.37, P=0.009). Only non–potassium-sparing diuretic use was independently associated with arrhythmic death (RR 1.33, P=0.02). Use of a potassium-sparing diuretic, alone or in combination with a non–potassium-sparing diuretic, was not independently associated with an increased risk of arrhythmic death (RR 0.90, P=0.6).

Conclusions—In SOLVD, baseline use of a non–potassium-sparing diuretic was associated with an increased risk of arrhythmic death, whereas baseline use of a potassium-sparing diuretic was not. These data suggest that diuretic-induced electrolyte disturbances may result in fatal arrhythmias in patients with systolic left ventricular dysfunction.

Key Words: diuretics • heart failure • arrhythmia • potassium

This article has been cited by other articles:

				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]

				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]

				M. Maeder, H. Rickli, C. Sticherling, R. Widmer, and P. Ammann Hypokalaemia and sudden cardiac death--lessons from implantable cardioverter defibrillators Emerg. Med. J., March 1, 2007; 24(3): 206 - 208. [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., November 28, 2006; (2006) j.jacc.2006.08.039v1. [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]

				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]

				R. C. Bourge and J. A. Tallaj Ultrafiltration: A New Approach Toward Mechanical Diuresis in Heart Failure J. Am. Coll. Cardiol., December 6, 2005; 46(11): 2052 - 2053. [Full Text] [PDF]

				W. S. Aronow Drug Treatment of Systolic and of Diastolic Heart Failure in Elderly Persons J. Gerontol. A Biol. Sci. Med. Sci., December 1, 2005; 60(12): 1597 - 1605. [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]

				S. Gupta and L. Neyses Diuretic usage in heart failure: a continuing conundrum in 2005 Eur. Heart J., April 1, 2005; 26(7): 644 - 649. [Abstract] [Full Text] [PDF]

				N. M. Albert, C. A. Eastwood, and M. L. Edwards Evidence-Based Practice for Acute Decompensated Heart Failure Crit. Care Nurse, December 1, 2004; 24(6): 14 - 29. [Full Text] [PDF]

				J. Marshall, J. W. Berkenbosch, P. Russo, and J. D. Tobias Preliminary Experience With Nesiritide in the Pediatric Population J Intensive Care Med, May 1, 2004; 19(3): 164 - 170. [Abstract] [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]

				J. E. Macdonald and A. D. Struthers What is the optimal serum potassium level in cardiovascular patients? J. Am. Coll. Cardiol., January 21, 2004; 43(2): 155 - 161. [Abstract] [Full Text] [PDF]

				B. Pitt Aldosterone Blockade in Patients With Systolic Left Ventricular Dysfunction Circulation, October 14, 2003; 108(15): 1790 - 1794. [Full Text] [PDF]

				M. Domanski, J. Norman, B. Pitt, M. Haigney, S. Hanlon, and E. Peyster Diuretic use, progressive heart failure, and death in patients in the studies of left ventricular dysfunction (SOLVD) J. Am. Coll. Cardiol., August 20, 2003; 42(4): 705 - 708. [Abstract] [Full Text] [PDF]

				A. F. Hernandez and C. M. O'Connor Sparing a little may save a lot: Lessons from the Studies of Left Ventricular Dysfunction (SOLVD) J. Am. Coll. Cardiol., August 20, 2003; 42(4): 709 - 711. [Full Text] [PDF]

				M. Gheorghiade, I. Niazi, J. Ouyang, F. Czerwiec, J.-i. Kambayashi, M. Zampino, and C. Orlandi Vasopressin V2-Receptor Blockade With Tolvaptan in Patients With Chronic Heart Failure: Results From a Double-Blind, Randomized Trial Circulation, June 3, 2003; 107(21): 2690 - 2696. [Abstract] [Full Text] [PDF]

				C A J Farquharson and A D Struthers Increasing plasma potassium with amiloride shortens the QT interval and reduces ventricular extrasystoles but does not change endothelial function or heart rate variability in chronic heart failure Heart, December 1, 2002; 88(5): 475 - 480. [Abstract] [Full Text] [PDF]

				E Allot, C de Chillou, and N Sadoul Ventricular instability and sudden death in patients with heart failure: lessons from clinical trials Eur. Heart J. Suppl., April 1, 2002; 4(suppl_D): D31 - D42. [Abstract] [PDF]

				F Zannad Evidence-based drug therapy for chronic heart failure Eur. Heart J. Suppl., April 1, 2002; 4(suppl_D): D66 - D72. [Abstract] [PDF]

				M. Naitoh, J. Risvanis, L. C. Balding, C. I. Johnston, and L. M. Burrell Neurohormonal antagonism in heart failure; beneficial effects of vasopressin V1a and V2 receptor blockade and ACE inhibition Cardiovasc Res, April 1, 2002; 54(1): 51 - 57. [Abstract] [Full Text] [PDF]

				M. de Lorgeril, P. Salen, P. Defaye, P. Mabo, and F. Paillard Dietary prevention of sudden cardiac death Eur. Heart J., February 2, 2002; 23(4): 277 - 285. [Full Text] [PDF]

				H. M. Fernandez, R. M. Leipzig, R. J. Larkin, S. A. Atlas, T. J. Donohue, D. Vanpee, C. Swine, G. Glick, B. Pitt, A. Perez, et al. Spironolactone in Patients with Heart Failure N. Engl. J. Med., January 13, 2000; 342(2): 132 - 134. [Full Text]

				Diuretics and the Risk for Arrhythmic Death Among Patients with LV Dysfunction Journal Watch Cardiology, October 14, 1999; 1999(1014): 4 - 4. [Full Text]

				Diuretics and Arrhythmic Death Journal Watch (General), September 28, 1999; 1999(928): 3 - 3. [Full Text]