Different diuretic regimes and long-term outcomes in heart failure with mildly reduced ejection fraction

This study investigates the prognostic impact of thiazide and loop diuretics in HFmrEF.</p> <p>Consecutive HFmrEF patients hospitalized at the University Medical Centre Mannheim between 2016 and 2022 were retrospectively included (HARMER registry, clinicaltrials.gov identifier: NCT05603390) and stratified by diuretic therapy at discharge: none (N), thiazide-only (T), loop diuretic-only (L), or combined diuretic therapy (T + L).

The primary endpoint was all-cause mortality at 30 months (median follow-up), secondary endpoint was HF-related rehospitalization.</p> <p>Among 2,109 HFmrEF patients discharged alive, 43% received no diuretics, 9% thiazides only, 40% loop diuretics only, and 9% combined diuretic therapy. Thiazide-only patients had the lowest of long-term all-cause mortality (11%) compared to no diuretics (20%), while patients with loop (39%), and combined diuretic therapy (48%) had higher long-term mortality rates (log-rank <i>p</i> = 0.001).