Persistent Outpatient Oral Loop Diuretic Use and Clinical Outcomes According to Left Ventricular Volume Phenotype in Heart Failure With Preserved Ejection Fraction

The study examined the relationship between persistent outpatient oral loop diuretic use and clinical outcomes in 12,748 patients with heart failure with preserved ejection fraction. Patients were stratified into two groups based on left ventricular size: 1,437 with small and 11,311 with normal left ventricular volume. Patients with small left ventricular volume initiated diuretics earlier and more frequently than those with normal volume. Diuretic use was associated with heart failure hospitalization in both groups, but the association was stronger in the small left ventricular group (hazard ratio 2.52) compared to the normal left ventricular group (hazard ratio 2.10). No significant difference between groups was found for worsening renal function and all-cause mortality. The results suggest that left ventricular volume phenotype may help identify patients who require closer monitoring and more individualized diuretic management.