Related Experiment Video
Updated: Dec 11, 2025
15:05
Functional Evaluation of Biological Neurotoxins in Networked Cultures of Stem Cell-derived Central Nervous System Neurons
Published on: February 5, 2015
9.7K
In-Hospital Therapy for Heart Failure With Reduced Ejection Fraction in the United States.
Stephen J Greene1, Taylor S Triana2, Raluca Ionescu-Ittu3
1Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina.
JACC. Heart Failure
|August 18, 2020
Summary
In-hospital treatment for heart failure with reduced ejection fraction (HFrEF) often escalates beyond initial therapy. More complex treatments correlate with longer hospital stays and increased mortality, necessitating standardized care approaches.
Area of Science:
- Cardiology
- Clinical Practice
- Health Outcomes Research
Background:
- Hospitalizations for heart failure (HF) are frequent and linked to adverse patient outcomes.
- Current real-world patterns of in-hospital treatment for HF, particularly diuretic therapy, in the U.S. are not well-defined.
Purpose of the Study:
- To characterize contemporary in-hospital treatment patterns for patients hospitalized with heart failure (HF) in the United States.
- To assess the association between these treatment patterns and patient outcomes.
Main Methods:
- Analysis of de-identified Electronic Health Record data (2007-2018) for patients hospitalized with HF with reduced ejection fraction (HFrEF; ejection fraction ≤40%).
- Patients were categorized into hierarchical treatment groups based on complexity, including intensified therapy, diuretic reinitiation, dose increase, or uncomplicated treatment.
- Inclusion criteria specified hemodynamic stability, absence of acute coronary syndrome or end-stage renal disease, and treatment with intravenous (IV) diuretics within 48 hours of admission.
Main Results:
- Of 22,677 HFrEF patients, 66% received uncomplicated treatment.
- Among the remaining patients, 39% received intensified therapy, 36% had IV diuretic reinitiation, and 25% had dose increases/combinations.
- More complex treatments (IV diuretic reinitiation, intensified therapy) were associated with significantly longer lengths of stay (8-10 days vs. 4 days) and higher in-hospital (4.2%-13.2% vs. 1.6%) and 30-day post-discharge mortality (9.7%-12.7% vs. 5.2%) compared to uncomplicated care.
Conclusions:
- Approximately one-third of hospitalized HFrEF patients in the U.S. experience treatment escalation beyond initial IV diuretics.
- These escalated treatment patterns are linked to variable diuretic use, prolonged hospitalizations, and increased mortality.
- There is a need for standardized, evidence-based strategies to enhance the effectiveness and efficiency of in-hospital HFrEF management.
