Comparison of all types of loop‐diuretics for chronic heart failure: A protocol for a systematic review and network meta‐analysis

Abstract Background Patients with chronic heart failure (CHF) experience congestion‐related symptoms such as dyspnoea and oedema, both of which are associated with poor outcomes. Loop diuretics are the cornerstone to treat congestion and to maintain euvolemia. While furosemide is the most used loop diuretic, other loop diuretics may exhibit theoretical advantages. We aim to compare all types of loop diuretics for patients with CHF. Methods This protocol for a systematic review is conducted with guidance from the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis Protocols. We will include randomised clinical trials (RCTs) of loop diuretics with other loop diuretics, placebo, or standard of care in CHF patients. The search will be conducted across the major medical databases (including Medline, Embase, and Cochrane Central Register of Controlled Trials). The searches will begin in February 2025. The primary outcome will be all‐cause mortality. Secondary outcomes will be all‐cause hospitalization, serious adverse events (SAEs), and changes in body weight (kg). Data will be analysed by traditional meta‐analyses, Trial Sequential Analyses (TSA), and network meta analysis. The risk of bias will be assessed using the Cochrane Risk of Bias tool—version 2. The certainty of the evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) and Confidence in Network Meta‐Analysis (CINEMA) approach.