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news.According to a new review of studies published by The Cochrane Collaboration, diuretics can reduce the risk of death, delay heart deterioration and improve exercise capacity in patients with congestive heart failure.
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Although widely used for quick relief of congestive heart failure (CHF) symptoms – cough, shortness of breath and swelling in the feet, legs and ankles – up until now it was not known whether diuretics had a more substantial effect in treating CHF.
Researchers looked at data from 525 patients from 14 randomized clinical trials – seven comparing diuretics with placebo and seven comparing diuretics with other heart medications in treating CHF. The studies involved three types of diuretics: thiazide, potassium-sparing and loop diuretics, such as Lasix.
The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration. The authors estimate that “80 deaths could be avoided for every 1,000 patients treated” with diuretics for CHF, but add that this evidence was based on only 15 deaths out of 221 participants from the studies that reported mortality rates.
The reviewers said diuretics, which help the body get rid of excess fluid, should be used in conjunction with other heart medications in treating CHF.
However, some doctors question whether the benefits of the drugs outweigh the risks. Diuretics can have serious side effects such as depleting electrolytes (potassium and magnesium), which can contribute to irregular heartbeat and kidney disorders.
“Diuretics are effective, easy to administer and inexpensive,” said Dr Clyde Yancy, of the University of Texas Southwestern Medical Center in Dallas. “Excessive use of diuretics provokes renal insufficiency. Importantly, changes in renal function do impart an additional risk for patients with heart failure.”
Proper dosing, Dr Yancy said, is key. “The hope is that physicians will use diuretics in a manner sufficient to relieve evidence of congestion but not to the extent that the risks of disturbance of electrolytes and renal function occur.
The Cochrane reviewers say that many of the studies they analyzed were small, with varying types and doses of diuretics compared, and that further research is needed to understand the optimal use and benefits of diuretic treatment.