Non-cardiovascular medication and readmission for heart failure: an observational cohort study

Publication authors: Kruik-Kollöffel WJ, Vallejo-Yagüe E,  Movig KLL,  Linssen GCM, Heintjes EM, van der Palen J.


Recent studies suggest that women are more susceptible to diuretic-induced hyponatremia resulting in hospital admission than men. The aim of this study was to confirm whether these sex differences in hyponatremia related hospital admissions in diuretic users remain after adjusting for several confounding variables such as age, dose, and concurrent medication.


In a case-control design nested in diuretic users, cases of hyponatremia associated hospital admissions between 2005-2017 were identified from the PHARMO Data Network. Cases were 1:10 matched to diuretic users as controls. Odds ratios (OR) with 95%CIs were calculated for women versus men and adjusted for potential confounders (age, number of diuretics, other hyponatremia-inducing drugs, chronic disease score) using unconditional logistic regression analysis. A subgroup analysis was performed for specific diuretic groups (thiazides, loop diuretics and aldosterone antagonists).


Women had a statistically significantly higher risk of a hospital admission associated with hyponatremia than men while using diuretics (OR 1.86, 95%CI 1.64-2.11). Adjusting for the potential confounders resulted in an increased risk for women compared to men (ORadj 2.65, 95% CI 2.31-3.04). This higher risk in women was also seen in the three subgroup analyses after adjustment.


Our findings show a higher risk of hyponatremia related hospital admission in women than men while using diuretics. Further research is needed to understand the underlying mechanism of this sex difference to be able to provide sex specific recommendations.

Share this article