Changing global prevalence of diuretic resistance amongst patients with heart failure: a systematic review and cumulative meta-analyses.

In 30 seconds

This systematic review and cumulative meta-analysis assessed diuretic resistance (DR) prevalence in adults with heart failure. Twelve prevalence-eligible observational or randomized studies contributed 24,904 patients, including 4,861 meeting study-defined DR criteria. The pooled prevalence was 23.0% (95% CI, 13.6%-36.2%), with substantial between-study heterogeneity (I²=98.5%). A robustness analysis using a generalized linear mixed model produced a similar estimate. Cumulative analysis showed that the pooled estimate shifted as eligible studies accrued, underscoring that prevalence depends on study populations and how DR is defined and assessed.

Key findings

• Across 12 studies and 24,904 patients, pooled DR prevalence was 23.0% (95% CI, 13.6%-36.2%).
• Between-study heterogeneity was substantial (I²=98.5%), and the 95% prediction interval was 3.4%-71.6%.
• A generalized linear mixed model yielded a similar pooled prevalence of 22.5% (95% CI, 14.5%-33.2%).
• Exploratory regression analysis did not show statistically significant funnel-plot asymmetry (p = 0.072).

Why it matters

DR is relevant to persistent congestion and adverse outcomes in heart failure, but this synthesis shows that its reported frequency varies markedly across settings and definitions. The pooled estimate offers a broad indication of burden, while the wide prediction interval cautions against applying it uniformly to individual populations. More consistent definitions and prospective prevalence studies would improve comparisons and inform clinical guidance.

What to keep in mind

The prevalence estimate is based on only 12 eligible studies and has extreme heterogeneity; the wide prediction interval indicates substantial variation across settings and study-defined criteria.