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[The value of aggressive diuretic therapy in acute decompensated stage of chronic heart failure]
1Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China.
Insights
Aggressive diuretic therapy for acute decompensated chronic heart failure (CHF) is safe and effective. This approach reduces hospital stay, costs, and mortality rates.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Acute decompensation of chronic heart failure (CHF) presents significant clinical challenges.
- Diuretic therapy is a cornerstone in managing fluid overload in CHF patients.
Purpose of the Study:
- To evaluate the efficacy and safety of aggressive diuretic therapy in patients with acute decompensated CHF.
- To assess the impact of aggressive diuretic therapy on hospital length of stay and associated expenses.
Main Methods:
- Retrospective analysis of 195 patients with acute decompensated CHF (NYHA class III-IV).
- Patients were categorized into aggressive (≥2400 ml urine/24h) and non-aggressive (<2400 ml urine/24h) diuretic therapy groups.
- Comparison of biochemical parameters, vital signs, mortality, length of stay, and expenses between groups.
Main Results:
- Aggressive diuretic therapy was associated with significantly lower mortality rates (1.4% vs. 9.8%, P<0.05).
- Patients receiving aggressive therapy experienced shorter hospital stays (11 vs. 16 days) and reduced total expenses.
- Significant reductions in systolic and diastolic blood pressure were observed post-therapy without adverse events.
Conclusions:
- Aggressive diuretic therapy is a safe and effective treatment for acute decompensated CHF.
- This therapeutic strategy can lead to decreased hospital length of stay, reduced healthcare costs, and lower in-hospital mortality.
Objective:
To evaluate both the efficacy, safety, length of stay in hospital and expenses of aggressive diuretic therapy in patients with acute decompensation of chronic heart failure (CHF).
Methods:
The retrospective analysis was conducted in the patients with acute decompensation CHF New York Heart Association (NYHA) class III or IV in department of cardiology of Fujian Medical University Union Hospital from January 1st 2006 to September 1st 2007. The 24-hour urine volume on the 2nd day was equivalent or over 2 400 ml was defined as aggressive diuretic therapy group, and those with less than 2 400 ml of urine as non-aggressive diuretic therapy group. The biochemical parameters and vital signs were compared before and after aggressive diuretic therapy, and the mortality, the length of stay and expenses were also compared between the two groups.
Results:
One hundred and ninety-five patients were enrolled in the study, there were 73 and 122 patients in aggressive diuretic therapy group and in non-aggressive diuretic therapy group respectively. The mortality in aggressive diuretic therapy group was lower than that in non-aggressive diuretic therapy group (1.4% vs. 9.8%, P<0.05). The length of stay, total expenses and average cost in aggressive diuretic therapy group were lower than those in non-aggressive diuretic therapy group respectively [the length of stay: 11 days vs. 16 days; total expenses: 8 483 yuan vs. 12 182 yuan; average expenseI: 721.1 yuan/d vs. 854.4 yuan/d; average expenseII (except for examination expenses): 580.0 yuan/d vs. 698.2 yuan/d, P<0.05 or P<0.01]. There were no significant changes in biochemical parameters and heart rate before and after aggressive diuretic therapy. The systolic pressure (SBP) and diastolic pressure (DBP) were reduced significantly after aggressive diuretic therapy [SBP: (118.2±16.9) mm Hg vs. (127.0±24.9) mm Hg; DBP: (67.2±4.5) mm Hg vs. (75.2±4.9) mm Hg, 1 mm Hg=0.133 kPa, P<0.05 and P<0.01]. No hypotension symptoms such as dizziness and chest distress were found in all patients.
Conclusion:
Aggressive diuretic therapy in patients with acute decompensation CHF is a safe, effective mode of therapy. It can reduce the length of stay in hospital, expenses and the mortality during hospitalization.
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