Use of Loop Diuretics is Associated with Increased Mortality in Patients with Suspected Coronary Artery Disease, but without Systolic Heart Failure or Renal Impairment: An Observational Study Using Propensity Score Matching
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Mendeley | Further Information

{"title"=>"Use of Loop Diuretics is Associated with Increased Mortality in Patients with Suspected Coronary Artery Disease, but without Systolic Heart Failure or Renal Impairment: An Observational Study Using Propensity Score Matching.", "type"=>"journal", "authors"=>[{"first_name"=>"Hall", "last_name"=>"Schartum-Hansen"}, {"first_name"=>"Kjetil H", "last_name"=>"Løland"}, {"first_name"=>"Gard F T", "last_name"=>"Svingen"}, {"first_name"=>"Reinhard", "last_name"=>"Seifert"}, {"first_name"=>"Eva R", "last_name"=>"Pedersen"}, {"first_name"=>"Jan E", "last_name"=>"Nordrehaug"}, {"first_name"=>"Øyvind", "last_name"=>"Bleie"}, {"first_name"=>"Marta", "last_name"=>"Ebbing"}, {"first_name"=>"Christ", "last_name"=>"Berge"}, {"first_name"=>"Dennis W T", "last_name"=>"Nilsen"}, {"first_name"=>"Ottar", "last_name"=>"Nygård"}], "year"=>2015, "source"=>"PloS one", "identifiers"=>{"pmid"=>"26030195", "doi"=>"10.1371/journal.pone.0124611", "issn"=>"1932-6203"}, "id"=>"1c4399cd-569a-37b1-8b19-c10d0e4322d8", "abstract"=>"BACKGROUND: Loop diuretics are widely used in patients with heart and renal failure, as well as to treat hypertension and peripheral edema. However, there are no randomized, controlled trials (RCT) evaluating their long term safety, and several observational reports have indicated adverse effects. We sought to evaluate the impact of loop diuretics on long term survival in patients with suspected coronary artery disease, but without clinical heart failure, reduced left ventricular ejection fraction or impaired renal function.\\n\\nMETHOD AND FINDINGS: From 3101 patients undergoing coronary angiography for suspected stable angina pectoris, subjects taking loop diuretics (n=109) were matched with controls (n=198) in an attempted 1:2 ratio, using propensity scores based on 59 baseline variables. During median follow-up of 10.1 years, 37.6% in the loop diuretics group and 23.7% in the control group died (log-rank p-value 0.005). Treatment with loop diuretics was associated with a hazard ratio (95% confidence interval) of 1.82 (1.20, 2.76), and the number needed to harm was 7.2 (4.1, 30.3). Inclusion of all 3101 patients using propensity score weighting and adjustment for numerous covariates provided similar estimates. The main limitation is the potential of confounding from unmeasured patient characteristics.\\n\\nCONCLUSIONS: The use of loop diuretics in patients with suspected coronary artery disease, but without systolic heart failure or renal impairment, is associated with increased risk of all-cause mortality. Considering the lack of randomized controlled trials to evaluate long term safety of loop diuretics, our data suggest caution when prescribing these drugs to patients without a clear indication.", "link"=>"http://www.mendeley.com/research/loop-diuretics-associated-increased-mortality-patients-suspected-coronary-artery-disease-without-sys-5", "reader_count"=>5, "reader_count_by_academic_status"=>{"Researcher"=>2, "Student > Ph. D. Student"=>1, "Other"=>2}, "reader_count_by_user_role"=>{"Researcher"=>2, "Student > Ph. D. Student"=>1, "Other"=>2}, "reader_count_by_subject_area"=>{"Medicine and Dentistry"=>4, "Pharmacology, Toxicology and Pharmaceutical Science"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>4}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>1}}, "group_count"=>0}

Scopus | Further Information

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/2091443"], "description"=>"<p>Abbreviations: CVD cardiovascular disease.</p><p>*Covariates: age, sex, study site, participation in the WENBIT study, smoking, family history of coronary heart disease, medical history (hypertension, diabetes, acute myocardial infarction, percutaneous intervention, coronary artery bypass surgery, peripheral vascular disease, cerebrovascular disease, cured cancer, active cancer (not in the cardiovascular mortality analyses due to failure of the model to converge), deep vein thrombosis or vein surgery, pulmonary disease, atrial fibrillation, dyspnea grade 0–4), measured parameters at baseline (body mass index, ECG rhythm, left ventricular ejection fraction, number of coronary vessels with >50% stenosis), laboratory values (estimated glomerular filtration rate, uric acid, hemoglobin, potassium, sodium, C-reactive protein, glycated hemoglobin, low density lipoprotein, troponin T), medication (aspirin, adenosine diphosphate receptor inhibitor, warfarin, angiotensin converting enzyme inhibitor and/or angiotensin receptor blocker, beta-blocker, digoxin, spironolactone, thiazide, calcium antagonist, nitrate, statin, insulin, metformin, sulfonylurea, treatment for chronic obstructive pulmonary disease, non-steroid anti-inflammatory drug, corticosteroid, antidepressant, antipsychotic), and baseline revascularization.</p><p>Cox regression survival models.</p>", "links"=>[], "tags"=>["term safety", "loop diuretics", "59 baseline variables", "Systolic Heart Failure", "Coronary artery disease", "artery disease", "FindingsFrom 3101 patients", "loop diuretics group", "propensity score weighting", "rct", "unmeasured patient characteristics.ConclusionsThe use"], "article_id"=>1433310, "categories"=>["Biological Sciences"], "users"=>["Hall Schartum-Hansen", "Kjetil H. Løland", "Gard F. T. Svingen", "Reinhard Seifert", "Eva R. Pedersen", "Jan E. Nordrehaug", "Øyvind Bleie", "Marta Ebbing", "Christ Berge", "Dennis W. T. Nilsen", "Ottar Nygård"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0124611.t002", "stats"=>{"downloads"=>1, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Cox_regression_survival_models_/1433310", "title"=>"Cox regression survival models.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-06-01 04:54:17"}
  • {"files"=>["https://ndownloader.figshare.com/files/2091439"], "description"=>"<p>Sensitivity plot showing how high the hazard ratio of a single, unknown, dichotomous confounder would have to be, at different levels of distribution among patients using loop diuretics and controls, to fully explain the observed risk of death associated with loop diuretics.</p>", "links"=>[], "tags"=>["term safety", "loop diuretics", "59 baseline variables", "Systolic Heart Failure", "Coronary artery disease", "artery disease", "FindingsFrom 3101 patients", "loop diuretics group", "propensity score weighting", "rct", "unmeasured patient characteristics.ConclusionsThe use"], "article_id"=>1433306, "categories"=>["Biological Sciences"], "users"=>["Hall Schartum-Hansen", "Kjetil H. Løland", "Gard F. T. Svingen", "Reinhard Seifert", "Eva R. Pedersen", "Jan E. Nordrehaug", "Øyvind Bleie", "Marta Ebbing", "Christ Berge", "Dennis W. T. Nilsen", "Ottar Nygård"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0124611.g003", "stats"=>{"downloads"=>1, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Sensitivity_plot_showing_how_high_the_hazard_ratio_of_a_single_unknown_dichotomous_confounder_would_have_to_be_at_different_levels_of_distribution_among_patients_using_loop_diuretics_and_controls_to_fully_explain_the_observed_risk_of_death_associated_wit/1433306", "title"=>"Sensitivity plot showing how high the hazard ratio of a single, unknown, dichotomous confounder would have to be, at different levels of distribution among patients using loop diuretics and controls, to fully explain the observed risk of death associated with loop diuretics.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-06-01 04:54:17"}
  • {"files"=>["https://ndownloader.figshare.com/files/2091434"], "description"=>"<p>Squares: Before matching. Diamonds: after matching.</p>", "links"=>[], "tags"=>["term safety", "loop diuretics", "59 baseline variables", "Systolic Heart Failure", "Coronary artery disease", "artery disease", "FindingsFrom 3101 patients", "loop diuretics group", "propensity score weighting", "rct", "unmeasured patient characteristics.ConclusionsThe use"], "article_id"=>1433301, "categories"=>["Biological Sciences"], "users"=>["Hall Schartum-Hansen", "Kjetil H. Løland", "Gard F. T. Svingen", "Reinhard Seifert", "Eva R. Pedersen", "Jan E. Nordrehaug", "Øyvind Bleie", "Marta Ebbing", "Christ Berge", "Dennis W. T. Nilsen", "Ottar Nygård"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0124611.g001", "stats"=>{"downloads"=>1, "page_views"=>13, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Absolute_standardized_mean_differences_for_baseline_characteristics_before_and_after_matching_/1433301", "title"=>"Absolute standardized mean differences for baseline characteristics before and after matching.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-06-01 04:54:17"}
  • {"files"=>["https://ndownloader.figshare.com/files/2091441"], "description"=>"<p>Continuous variables are shown as means (standard deviation) and medians (interquartile range) and categorical variables as numbers (percentage). Abbreviations: WENBIT = WEstern Norway B-vitamin Trial; CAD = coronary artery disease; PCI = percutaneous coronary intervention; CABG = coronary artery bypass graft; PVD = peripheral vascular disease; DVT = deep venous thrombosis; NYHA = New York Heart Association; BP = blood pressure; eGFR = estimated glomerular filtration rate; HbA1c = glycated hemoglobin; WBC = white blood cell count; ACEI = angiotensin converting enzyme inhibitor; ARB = angiotensin receptor blocker; COPD = chronic obstructive pulmonary disease; NSAID = non-steroid anti-inflammatory drug.</p><p>Baseline characteristics after matching.</p>", "links"=>[], "tags"=>["term safety", "loop diuretics", "59 baseline variables", "Systolic Heart Failure", "Coronary artery disease", "artery disease", "FindingsFrom 3101 patients", "loop diuretics group", "propensity score weighting", "rct", "unmeasured patient characteristics.ConclusionsThe use"], "article_id"=>1433308, "categories"=>["Biological Sciences"], "users"=>["Hall Schartum-Hansen", "Kjetil H. Løland", "Gard F. T. Svingen", "Reinhard Seifert", "Eva R. Pedersen", "Jan E. Nordrehaug", "Øyvind Bleie", "Marta Ebbing", "Christ Berge", "Dennis W. T. Nilsen", "Ottar Nygård"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0124611.t001", "stats"=>{"downloads"=>1, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Baseline_characteristics_after_matching_/1433308", "title"=>"Baseline characteristics after matching.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-06-01 04:54:17"}
  • {"files"=>["https://ndownloader.figshare.com/files/2091435"], "description"=>"<p>The p-value for difference was calculated using log-rank test.</p>", "links"=>[], "tags"=>["term safety", "loop diuretics", "59 baseline variables", "Systolic Heart Failure", "Coronary artery disease", "artery disease", "FindingsFrom 3101 patients", "loop diuretics group", "propensity score weighting", "rct", "unmeasured patient characteristics.ConclusionsThe use"], "article_id"=>1433302, "categories"=>["Biological Sciences"], "users"=>["Hall Schartum-Hansen", "Kjetil H. Løland", "Gard F. T. Svingen", "Reinhard Seifert", "Eva R. Pedersen", "Jan E. Nordrehaug", "Øyvind Bleie", "Marta Ebbing", "Christ Berge", "Dennis W. T. Nilsen", "Ottar Nygård"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0124611.g002", "stats"=>{"downloads"=>1, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Kaplan_Meier_plot_showing_survival_curves_for_patients_using_loop_diuretics_and_matched_controls_/1433302", "title"=>"Kaplan-Meier plot showing survival curves for patients using loop diuretics and matched controls.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-06-01 04:54:17"}
  • {"files"=>["https://ndownloader.figshare.com/files/2091449", "https://ndownloader.figshare.com/files/2091450", "https://ndownloader.figshare.com/files/2091451", "https://ndownloader.figshare.com/files/2091452"], "description"=>"<div><p>Background</p><p>Loop diuretics are widely used in patients with heart and renal failure, as well as to treat hypertension and peripheral edema. However, there are no randomized, controlled trials (RCT) evaluating their long term safety, and several observational reports have indicated adverse effects. We sought to evaluate the impact of loop diuretics on long term survival in patients with suspected coronary artery disease, but without clinical heart failure, reduced left ventricular ejection fraction or impaired renal function.</p><p>Method and Findings</p><p>From 3101 patients undergoing coronary angiography for suspected stable angina pectoris, subjects taking loop diuretics (n=109) were matched with controls (n=198) in an attempted 1:2 ratio, using propensity scores based on 59 baseline variables. During median follow-up of 10.1 years, 37.6% in the loop diuretics group and 23.7% in the control group died (log-rank p-value 0.005). Treatment with loop diuretics was associated with a hazard ratio (95% confidence interval) of 1.82 (1.20, 2.76), and the number needed to harm was 7.2 (4.1, 30.3). Inclusion of all 3101 patients using propensity score weighting and adjustment for numerous covariates provided similar estimates. The main limitation is the potential of confounding from unmeasured patient characteristics.</p><p>Conclusions</p><p>The use of loop diuretics in patients with suspected coronary artery disease, but without systolic heart failure or renal impairment, is associated with increased risk of all-cause mortality. Considering the lack of randomized controlled trials to evaluate long term safety of loop diuretics, our data suggest caution when prescribing these drugs to patients without a clear indication.</p></div>", "links"=>[], "tags"=>["term safety", "loop diuretics", "59 baseline variables", "Systolic Heart Failure", "Coronary artery disease", "artery disease", "FindingsFrom 3101 patients", "loop diuretics group", "propensity score weighting", "rct", "unmeasured patient characteristics.ConclusionsThe use"], "article_id"=>1433313, "categories"=>["Biological Sciences"], "users"=>["Hall Schartum-Hansen", "Kjetil H. Løland", "Gard F. T. Svingen", "Reinhard Seifert", "Eva R. Pedersen", "Jan E. Nordrehaug", "Øyvind Bleie", "Marta Ebbing", "Christ Berge", "Dennis W. T. Nilsen", "Ottar Nygård"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0124611.s001", "https://dx.doi.org/10.1371/journal.pone.0124611.s002", "https://dx.doi.org/10.1371/journal.pone.0124611.s003", "https://dx.doi.org/10.1371/journal.pone.0124611.s004"], "stats"=>{"downloads"=>4, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Use_of_Loop_Diuretics_is_Associated_with_Increased_Mortality_in_Patients_with_Suspected_Coronary_Artery_Disease_but_without_Systolic_Heart_Failure_or_Renal_Impairment_An_Observational_Study_Using_Propensity_Score_Matching_/1433313", "title"=>"Use of Loop Diuretics is Associated with Increased Mortality in Patients with Suspected Coronary Artery Disease, but without Systolic Heart Failure or Renal Impairment: An Observational Study Using Propensity Score Matching", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2015-06-01 04:54:17"}

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Relative Metric

{"start_date"=>"2015-01-01T00:00:00Z", "end_date"=>"2015-12-31T00:00:00Z", "subject_areas"=>[]}
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Source
Counter
Time
2019-04-06 02:38:57 UTC
Target URL
http://counter-101.soma.plos.org/api/v1.0/stats/doi/10.1371%2Fjournal.pone.0124611
Trace

/app/models/concerns/networkable.rb:21:in `get_result'
/app/models/source.rb:165:in `get_data'
/app/models/retrieval_status.rb:47:in `perform_get_data'
/app/jobs/source_job.rb:52:in `block (2 levels) in perform'
/app/jobs/source_job.rb:51:in `block in perform'
/app/jobs/source_job.rb:35:in `each'
/app/jobs/source_job.rb:35:in `perform'