Outpatient diuretic intensification as endpoint in heart failure with preserved ejection fraction trials: An analysis from TOPCAT

European Journal of Heart FailureFerreira JP, Liu J, Claggett BL, et al. | November 29, 2021


A frequent occurrence of outpatient diuretic intensification (ODI) was evident in patients with heart failure (HF) and a preserved ejection fraction (HFpEF), and also ODI independently related to subsequent cardiovascular events in such patients. An extended composite outcome incorporating ODI was significantly reduced by treatment with spironolactone.

  • Participants included 1,767 patients enrolled in TOPCAT-Americas, in whom the frequency, prognostic impact, as well as the effect of spironolactone on ODI was examined.

  • ODI occurred in 38.8% of patients and was linked with a higher risk of subsequent cardiovascular events and death [adjusted hazard ratio (HR) for HF hospitalization or cardiovascular death 1.67; HR for cardiovascular death 2.17); and HR for all-cause death 1.75].

  • Use of spironolactone resulted in a 26% relative decrease of the extended composite of ODI or HF hospitalization or cardiovascular death (HR 0.74) vs a 16% relative decrease of HF hospitalization or cardiovascular death (HR 0.84).

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