Mortality is significantly increased following a hospitalization for decompensated heart failure (HF), during which diuretics are observed to be intensified. It remains indefinite how risk is affected after intensification of outpatients diuretic therapy for HF.

Danish patients diagnosed with HF from administrative registers were identified, from the years 2001 to 2016 and received β blocker and angiotensin‐converting enzyme angiotensin/inhibitor receptor blocker within the first 120 days. 74 990 patients were involved in this study, their median age was 71 years, and 36% were women. Intensification events were associated with significantly increased mortality at all times during follow‐up. After an intensification event, mortality was 22.6% after HF hospitalization, one-year mortality was 18%, and 10.4% for matched controls with neither. In a multivariable Cox model adjusted for ischemic heart disease, diabetes mellitus, atrial fibrillation, sex, chronic obstructive pulmonary disease, and age, the hazard ratio for 1‐year death after an intensification event was 1.75, and it was 2.28 after HF hospitalization. In a nationwide cohort of patients with HF, intensification events of outpatients were associated with a twice fold risk of mortality during the upcoming year.

In conclusion, although HF hospitalizations were associated with a greater risk, outpatients with an intensification event must receive a thorough re-evaluation for considering advanced options as patients hospitalized for worsening HF and drug therapy optimization.

Ref: https://www.ahajournals.org/doi/10.1161/JAHA.119.016010