Prescription patterns of diuretics in chronic heart failure: A contemporary background as a clue to their role in treatment**********

Abstract Background: Diuretics are the cornerstone of treatment for the congestive symptoms of heart failure (HF). Despite their widespread use, diuretic prescription data in clinical practice are scarce. In this study we evaluated the prescription pattern of diuretics in a large population of HF outpatients, enrolled by a national network of hospital-based cardiologists. Methods and Results: Among 11,070 HF outpatients (mean age 64 ± 12 years, 72.9% men, 29.8% New York Heart Association [NYHA] class III-IV, mean left ventricular ejection fraction [LVEF] 35±12%), 9247 took a diuretic, the most frequently prescribed therapeutic agent (83.5%). Loop diuretics were prescribed alone (65.5%) or combined with other diuretics in 91.6% of patients. By multivariate analysis, the strongest independent predictors of diuretic use were a previous hospital admission for HF (odds ratio [OR] 2.55, 95% confidence interval [CI] 2.28-2.86), NYHA class III-IV (OR 2.52, 95% CI 2.14-2.96), LVEF Conclusions: In this wide series of stable HF outpatients, cardiologists prescribed diuretics in accordance with published guidelines. Evolving prescription patterns of aldosterone-receptor blockers need to be further evaluated.