Abstract 17673: Loop Diuretic Use in the Months and Years Preceding a Heart Failure Diagnosis: A Case-control Study
Objective: To understand the prescribing of loop diuretics in primary care patients without a heart failure (HF) diagnosis and to determine if their use signals an increased probability of a future HF diagnosis.
Background: Loop diuretics are routinely prescribed for patients with HF to minimize symptoms due to fluid overload but relatively little is known about prescribing patterns in individuals preceding a formal HF diagnosis.
Methods: A nested case-control study of 1,288 new-onset (incident) HF cases and 10,319 matched controls was completed with electronic health record (EHR) data extracted between 2001- 2010 from primary care practices affiliated with the Geisinger Health System. New loop diuretic prescriptions, and associated orders <36 months before and 12 months after an incident HF diagnosis in cases, and a comparable time in controls were evaluated.
Results: Loop diuretic use was significantly greater (11.3% versus 3.5%, p<0.001) in future HF cases compared with controls 2 to 3 years preceding a HF diagnosis. Their use progressively increased in cases such that by 3 to 5 months preceding a HF diagnosis 27.1% of cases versus 7.5% of controls (P<0.001) had been prescribed a loop diuretic. Edema (ICD-9 782.3) and essential hypertension (ICD-9 401.x) were the most commonly associated diagnoses for starting a loop diuretic in both eventual HF cases as well as in controls. By multivariate analysis, being prescribed a loop diuretic was one of the strongest clinical predictors of an eventual diagnosis of HF (OR 2.44, 95% CI: 2.10-2.83, p<0.001).
Conclusions: In primary care, loop diuretic use is not uncommon in the months and years preceding a formal incident HF diagnosis. These results suggest there is substantial opportunity to improve the diagnosis and earlier treatment of individuals with HF.
Author Disclosures: D.A. Knorek: None. S.R. Steinhubl: None. C. deFilippi: None. K. Ng: None. R.J. Byrd: None. Z. Daar: None. W.F. Setwart: None.
- © 2016 by American Heart Association, Inc.