{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T11:59:02Z","timestamp":1780487942799,"version":"3.54.1"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2021,6,28]],"date-time":"2021-06-28T00:00:00Z","timestamp":1624838400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Heart Fail"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Loop diuretics (LD) relieve symptoms and signs of congestion due to heart failure (HF), but many patients prescribed LD do not have such a diagnosis. We studied the relationship between HF diagnosis, use of LD, and outcomes in patients with type 2 diabetes mellitus (T2DM) enrolled in the EMPA\u2010REG OUTCOME trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>\n                      The relationship between HF diagnosis, use of LD, and outcomes was evaluated in four patient subgroups with T2DM: (i) investigator\u2010reported HF on LD, (ii) investigator\u2010reported HF not on LD, (iii) no HF on LD, and (iv) no HF and not on LD, and we assessed their risk of cardiovascular events. Of 7020 participants, 706 (10%) had a diagnosis of HF at baseline, of whom 334 were prescribed LD. However, 755 (11%) patients who did not have a diagnosis of HF were prescribed LD. Compared to those with neither HF nor prescribed LD (reference group; placebo), those with both HF and receiving LD had the highest rates for all\u2010cause [hazard ratio (HR) (95% confidence interval) 3.19 (2.03\u20135.01)] and cardiovascular mortality [3.83 [(2.28\u20136.44)], and HF hospitalizations [9.51 (5.61\u201316.14)]. Patients without HF but prescribed LD had higher rates for all three outcomes [1.62 (1.10\u20132.39); 1.97 (1.26\u20133.08); 3.20 (1.90\u20135.39)], which were similar to patients with HF who were not receiving LD [1.42 (0.78\u20132.57); 1.56 (0.78\u20133.11); 3.00 (1.40\u20136.40)]. Empagliflozin had similar benefits regardless of subgroup (\n                      <jats:italic>P<\/jats:italic>\n                      for interaction &gt;0.1 for all outcomes).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients with T2DM prescribed LD are at greater risk of cardiovascular events even if they are not reported to have HF; this might reflect under\u2010diagnosis. Empagliflozin was similarly effective in all subgroups investigated.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.2220","type":"journal-article","created":{"date-parts":[[2021,5,24]],"date-time":"2021-05-24T23:30:40Z","timestamp":1621899040000},"page":"1085-1093","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Use of diuretics and outcomes in patients with type 2 diabetes: findings from the\n                    <scp>EMPA\u2010REG OUTCOME<\/scp>\n                    trial"],"prefix":"10.1093","volume":"23","author":[{"given":"Pierpaolo","family":"Pellicori","sequence":"first","affiliation":[{"name":"Robertson Centre for Biostatistics University of Glasgow  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Fitchett","sequence":"additional","affiliation":[{"name":"St. Michael's Hospital, Division of Cardiology University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikhail N.","family":"Kosiborod","sequence":"additional","affiliation":[{"name":"Saint Luke's Mid America Heart Institute"},{"name":"University of Missouri\u2010Kansas City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne P.","family":"Ofstad","sequence":"additional","affiliation":[{"name":"Boehringer Ingelheim Norway KS  Asker Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leo","family":"Seman","sequence":"additional","affiliation":[{"name":"Boehringer Ingelheim Pharmaceuticals Incorporated  Ridgefield CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Zinman","sequence":"additional","affiliation":[{"name":"Lunenfeld\u2010Tanenbaum Research Institute Mount Sinai Hospital, University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Zwiener","sequence":"additional","affiliation":[{"name":"Boehringer Ingelheim Pharma GmbH &amp; Co KG  Ingelheim Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Wanner","sequence":"additional","affiliation":[{"name":"Department of Medicine Wuerzburg University Clinic  Wuerzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jyothis","family":"George","sequence":"additional","affiliation":[{"name":"Boehringer Ingelheim International GmbH &amp; Co KG  Ingelheim Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvio E.","family":"Inzucchi","sequence":"additional","affiliation":[{"name":"Section of Endocrinology Yale School of Medicine  New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey M.","family":"Testani","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine Yale University School of Medicine  New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John G.F.","family":"Cleland","sequence":"additional","affiliation":[{"name":"Robertson Centre for Biostatistics University of Glasgow  Glasgow 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