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Outcomes With Ultrafiltration Among Hospitalized Patients With Acute Heart Failure (from the National Inpatient
Ali Yazdanyar1, Julien Sanon2, Kevin Bryan Lo3
1Department of Emergency and Hospital Medicine, Lehigh Valley Hospital-Cedar Crest, Allentown, Pennsylvania; Morsani College of Medicine, University of South Florida, Tampa, Florida.
The American Journal of Cardiology
|December 7, 2020
Summary
Ultrafiltration (UF) in acute heart failure (HF) patients identifies a high-risk group with more comorbidities. These patients face higher mortality and increased healthcare costs, suggesting a need for integrated cardiorenal care.
Area of Science:
- Cardiology
- Nephrology
- Critical Care Medicine
Background:
- Acute heart failure (HF) management requires balancing cardiac and renal functions.
- Pharmacologic diuresis is standard for decompensated HF, but ultrafiltration (UF) offers a non-pharmacologic option for diuretic resistance.
Purpose of the Study:
- To analyze the characteristics and outcomes of hospitalizations involving ultrafiltration (UF) in acute heart failure (HF) patients.
- To compare patients receiving UF with those not receiving UF regarding demographics, comorbidities, and resource utilization.
Main Methods:
- Cross-sectional analysis of National Inpatient Sample data (2009-2014).
- Inclusion criteria: HF diagnosis, age >18, no end-stage kidney disease, acute kidney injury, or prior hemodialysis/hemofiltration.
- Comparison of hospitalizations with and without UF.
Main Results:
- Hospitalizations with UF involved younger patients with higher rates of chronic kidney disease, diabetes, and comorbidities (Charlson score ≥2).
- UF group had significantly higher all-cause mortality (4.68% vs 2.24%), longer length of stay (6.2 vs 4.3 days), and higher average charges ($42,035 vs $24,867).
- Adjusted analysis showed UF associated with increased odds of mortality (OR 3.36), longer stays (OR 2.46), and higher charges (+72%).
Conclusions:
- Ultrafiltration in HF identifies a sicker patient subgroup with greater comorbidity burden, higher mortality risk, and increased resource utilization.
- These findings underscore the need for a multidisciplinary cardiorenal approach for HF patients requiring UF to improve outcomes and manage resource demands.
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