Comparative effects of long and short-acting loop diuretics on mortality in patients with chronic heart failure

Background: We previously reported that the long-acting loop diuretic azosemide improves cardiac sympathetic nerve activity (CSNA) in patients with chronic heart failure (CHF), compared with short-acting furosemide. However, its influence on mortality has not been determined. Methods: The present study was a further analysis of our previously published study in which azosemide showed improved 123I-metaiodobenzylguanidine scintigraphic findings compared with furosemide in CHF patients with reduced left ventricular ejection fraction (LVEF). Patients with CHF were identified according to their histories of acute decompensated heart failure requiring hospitalization. A total of 108 patients were selected and propensity score matching was used to compare patients treated with azosemide (n = 54) or furosemide (n = 54). Results: During the median follow-up period of 5.22 years, 24 out of 108 patients experienced cardiac death events. In multivariate Cox regression analysis (adjusted for age, non-beta-blocker treatments, and impaired CSNA), furosemide treatment was an independent predictor of cardiac death events (p = 0.034, hazard ratio 2.624, 95% confidence interval 1.074 to 6.047). On Kaplan-Meier analysis, the cardiac death-free rate in the azosemide group was significantly higher than that in the furosemide group (p < 0.05). Conclusions: These findings indicate the superior effectiveness of azosemide in reducing mortality compared with furosemide. (C) 2017 Elsevier B.V. All rights reserved.