Highlights
- •For patients admitted with ADHF, observation on an oral loop diuretic for <24 hours was associated with significantly higher 30-day HF readmission.
- •Observation on an oral loop diuretic for ≥24 hours before discharge in patients presenting with ADHF should be strongly considered.
- •Prospective studies are warranted to confirm these results and determine the optimal duration of observation on an oral loop diuretic before discharge.
Abstract
Background
Heart failure (HF) is associated with high 30-day readmission rates and places significant
financial burden on the health care system. The aim of this study was to determine
if the duration of observation on an oral loop diuretic before discharge is associated
with a reduction in 30-day HF readmission in patients with acute decompensated HF
(ADHF).
Methods and Results
This was a retrospective study of adult patients admitted for ADHF at a large academic
medical center. A total of 123 patients were included. Baseline characteristics were
similar between groups. The primary outcome of 30-day HF readmission occurred in 11
of 61 patients (18%) observed on an oral loop diuretic for <24 hours and in 2 of 62
patients (3.2%) observed on an oral loop diuretic for ≥24 hours (P = .023). Readmissions for 60- and 90-day HF were also significantly lower in patients
observed for ≥24 hours (P = .014 and P = .049, respectively). Associations became stronger after multivariate analysis (P < .001). Observation for <24 hours and previous admission within 30 days were independent
predictors of 30-day HF readmission (P = .03).
Conclusions
Observation of patients on an oral loop diuretic for <24 hours was associated with
significantly higher 30-day HF readmission. Therefore, observation on an oral loop
diuretic for ≥24 hours before discharge in patients presenting with ADHF should be
strongly considered.
Key Words
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References
- 2013 ACCF/AHA guideline for the management of heart failure.J Am Coll Cardiol. 2013; 62: e147-239https://doi.org/10.1016/j.jacc.2013.05.019
- HFSA 2010 Comprehensive Heart Failure Practice Guideline.J Card Fail. 2010; 16: e1-194https://doi.org/10.1016/j.cardfail.2010.04.004
- 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure.Eur Heart J. 2016; 37: 2129-2200https://doi.org/10.1093/eurheartj/ehw128
- Assessing and grading congestion in acute heart failure: a scientific statement from the Acute Heart Failure Committee of the Heart Failure Association of the European Society of Cardiology and Endorsed by the European Society of Intensive Care Medicine.Eur J Heart Fail. 2010; 12: 423-433
- Early management of patients with acute heart failure: State of the art and future directions. A consensus document from the Society for Academic Emergency Medicine/Heart Failure Society of America Acute Heart Failure Working Group.J Card Fail. 2015; 21: 27-43
- Heart disease and stroke statistics—2015 update: a report from the American Heart Association.Circulation. 2015; 131: e29-417
- The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries.J Am Coll Cardiol. 2014; 63: 1123-1133
- Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association.Circ Hear Fail. 2013; 6: 606-619
- Healthcare Cost and Utilization Project.(Available at:) (Accessed January 1, 2016)
- Use of intravenous diuretics on day of discharge in adults hospitalized for heart failure.J Card Fail. 2014; 20: 706-707
- Diuretic strategies in patients with acute decompensated heart failure.N Engl J Med. 2014; 364: 797-805
- Continuous versus bolus dosing of furosemide for patients hospitalized for heart failure.Am J Cardiol. 2010; 105: 1794-1797
- Continuous versus intermittent infusion of furosemide in acute decompensated heart failure.J Card Fail. 2010; 16: 188-193
- Ultrafiltration in decompensated heart failure with cardiorenal syndrome.N Engl J Med. 2012; 367: 2296-2304
- The effects of diuresis on the pharmacokinetics of the loop diuretics furosemide and torsemide in patients with heart failure.Am J Med. 1998; 104: 533-538
- Clinical pharmacokinetics of drugs in patients with heart failure: an update (part 2, drugs administered orally).Clin Pharmacokinet. 2014; 53: 1083-1114
- Gastrointestinal and liver issues in heart failure.Circulation. 2016; 133: 1696-1703
- Discharge diuretic dose and 30-day readmission rate in acute decompensated heart failure.Ann Pharmacother. 2016; 50: 437-445
- Loop diuretic dose adjustments after a hospitalization for heart failure: insights from ASCEND-HF.Eur J Heart Fail. 2015; 17: 340-346
- Factors associated with 30-day readmission of patients with heart failure from a Japanese administrative database.BMC Cardiovasc Disord. 2015; 15: 134
- Prospective development and validation of a model to predict heart failure hospitalisation.Heart. 2014; 100: 923-929
- Incidence and predictors of rehospitalization of acute heart failure patients.Int Heart J. 2015; 56: 219-225
- Meta-analysis of risks for short-term readmission in patients with heart failure.Am J Cardiol. 2015; 117: 626-632
- A diuretic protocol increases volume removal and reduces readmissions among hospitalized patients with acute decompensated heart failure.Congest Hear Fail. 2013; 19: 53-60
- Development of a collaborative transitions-of-care program for heart failure patients.Am J Heal Pharm. 2015; 72: 1147-1152
- Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial.J Am Geriatr Soc. 2004; 52: 675-684
- Home diuretic protocol for heart failure: partnering with home health to improve outcomes and reduce readmissions.Perm J. 2014; 18: 44-48
- Protocol-driven allied health post-discharge transition clinic to reduce hospital readmissions in heart failure.J Am Heart Assoc. 2015; 4: e002296
- Comparison of ambulatory, high-dose, intravenous diuretic therapy to standard hospitalization and diuretic therapy for treatment of acute decompensated heart failure.Am J Cardiol. 2016; 118: 1350-1355
- Timeliness of outpatient follow-up: an evidence-based approach for planning after hospital discharge.Ann Fam Med. 2015; 13: 115-122
- Relationship between early physician follow-up and 30-day readmission among medicare beneficiaries hospitalized for heart failure.JAMA. 2010; 303: 1716-1722
- Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials.JAMA Intern Med. 2014; 174: 1095-1107
- Simulation study of confounder-selection strategies.Am J Epidemiol. 1993; 138: 923-936
Article info
Publication history
Published online: July 05, 2017
Accepted:
June 29,
2017
Received in revised form:
June 9,
2017
Received:
February 11,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
