AFib Without HF: Loop Diuretic Use Tied to a Higher Risk of HF Hospitalisation and Death

Pavankumar Kamat


August 25, 2021


  • A significant proportion of patients with atrial fibrillation (AF) were prescribed loop diuretic agents, even without a formal diagnosis of heart failure (HF) and had an increased risk of HF hospitalisation and death.

Why this matters

  • Findings suggest that targeted evaluation of patients with AF may allow earlier HF diagnosis, timely intervention with guideline-recommended HF therapy and better outcomes, particularly in women with AF who have a higher prevalence of unrecognised HF.

Study design

  • A population-based cohort study of 124,256 people with incident AF from the UK Clinical Practice Research Datalink linked to secondary care records from Hospital Episodes Statistics and national death registration data.

  • Repeat prescriptions for loop diuretics, without a diagnosis of HF or documented non-cardiac indication, were classified as isolated loop diuretic use.

  • Funding: Imperial College London.

Key results

  • Of 124,256 patients with incident AF, 22,001 (17.7%) had a prior or concomitant diagnosis of HF and 22,325 (18.0%) had isolated loop diuretic use.

  • During a median follow-up of 2.9 years, 12,182 patients were diagnosed with HF (incidence rate, 3.2/100 person-years [95% CI, 3.1-3.3]).

  • Of these, 3999 (32.8%) had prior isolated loop diuretic use, including 1228/3964 (31%) patients diagnosed with HF following an unplanned hospitalisation.

  • The median time from AF to HF diagnosis was 3.6 (1.2-7.7) years in men vs 5.1 (1.8-9.9) years in women (P=.0001).

  • Patients with isolated loop diuretic use vs those without HF or loop diuretic use had an increased risk of (adjusted HR; 95% CI):

    • mortality (1.42; 1.37-1.47); and

    • unplanned HF hospitalisation (1.60; 1.42-1.80; P<.0005 for both).


  • Risk of residual confounding.

Zakeri R, Morgan AD, Sundaram V, Bloom C, Cleland JGF, Quint JK. Under-recognition of heart failure in patients with atrial fibrillation and the impact of gender: a UK population-based cohort study. BMC Med. 2021;19(1):179. doi: 10.1186/s12916-021-02048-8. PMID: 34372832.  View full text

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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