Brisco–Bacik MA, et al. – In this study, the relationship between metolazone use during acute decompensated HF (ADHF) and mortality utilizing propensity score adjustment was explored. A strong and independent association was found between metolazone use and increased mortality. Furthermore, this survival disadvantage was mediated predominantly by the hyponatremia, hypokalemia and worsening renal function (WRF) metolazone induces.