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Intravenous fluids in acute decompensated heart failure
Behnood Bikdeli1, Kelly M Strait2, Kumar Dharmarajan3
1Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
JACC. Heart Failure
|February 10, 2015
Summary
Early intravenous fluid administration in acute decompensated heart failure (HF) patients receiving diuretics is common and varies by hospital. This practice is linked to worse patient outcomes, including increased mortality.
Area of Science:
- Cardiology
- Hospital Medicine
- Critical Care Medicine
Background:
- Intravenous fluids are a common intervention for hospitalized patients.
- The early use of intravenous fluids in acute decompensated heart failure (ADHF) patients treated with diuretics is not well-characterized.
Purpose of the Study:
- To determine the utilization of intravenous fluids in the early management of ADHF patients receiving loop diuretics.
- To assess the association between early intravenous fluid administration and in-hospital adverse outcomes.
Main Methods:
- Retrospective cohort study of 131,430 hospitalizations for ADHF across 346 hospitals (2009-2010).
- Assessed intravenous fluid use within the first 2 days of hospitalization.
- Analyzed variations in fluid administration across hospitals and patient groups.
Main Results:
- 11% of ADHF hospitalizations received intravenous fluids (median 1,000 ml) in the first 2 days.
- Patients receiving fluids had significantly higher rates of critical care admission, intubation, renal replacement therapy, and hospital death.
- Wide variation in fluid administration was observed across hospitals (0% to 71%).
Conclusions:
- Early intravenous fluid administration is prevalent in ADHF patients treated with diuretics and exhibits significant hospital-level variation.
- This practice is associated with poorer in-hospital outcomes and requires further investigation.
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