Author + information
- Benjamin Laliberte,
- Brent Reed,
- Sandeep Devabhakthuni,
- Kristin Watson,
- Vijay Ivaturi,
- Tao Liu and
- Stephen Gottlieb
Background: Heart failure (HF) is associated with high 30-day readmission rates and represents a significant financial burden to the health care system. Guidelines recommend intravenous loop diuretics to manage volume overload in patients presenting with acute decompensated HF (ADHF), but minimal guidance is provided on how these drugs should be managed as patients approach euvolemia. Current recommendations advise observing patients with ADHF for at least 24 hours on oral loop diuretics prior to discharge. However, we are not aware of any evidence to support this recommendation.
Methods: This was a retrospective single-center study of adult patients 18-89 years of age admitted for ADHF at a large urban academic medical center. Inclusion criteria were an International Classification of Diseases code for ADHF, discharge from a cardiology service, electronic order for an intravenous loop diuretic, and documentation of an oral loop diuretic upon discharge. Patients were excluded if their hospital length of stay was less than 48 hours, referred to palliative care, or required dialysis. The primary outcome was all-cause 30-day hospital readmission rate.
Results: One hundred twenty-three patients were included. Baseline characteristics and discharge medications were similar between groups. The mean time (SD) observed on oral loop diuretics were 86 hours (122.2) versus 7.6 (9.1) hours. The primary outcome of 30-day HF readmission occurred in 11 of 61 patients (18.0%) observed on oral loop diuretics for less than 24 hours and in two of 62 patients (3.2%) observed on oral loop diuretics for greater than 24 hours (p=0.023). After controlling for confounders, the association was stronger (p <0.001). The 60- and 90-day HF readmission rates were also significantly lower (p<0.001). Observation less than 24 hours and prior readmission within 30 days were identified as independent predictors for 30-day HF readmission (p=0.03).
Conclusions: Patients observed on oral loop diuretics for greater than 24 hours demonstrated significantly lower 30-, 60-, and 90-day HF readmission rates, lending the first evidence-based support for this guideline recommendation. Future prospective trials are warranted.
Moderated Poster Contributions
Heart Failure and Cardiomyopathies Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:10 a.m.
Session Title: Why Can't We Be Friends? Controversies in Heart Failure Management
Abstract Category: 14. Heart Failure and Cardiomyopathies: Therapy
Presentation Number: 1137M-03
- 2017 American College of Cardiology Foundation