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In-Hospital Observation on Oral Diuretics After Treatment for Acute Decompensated Heart Failure: Evaluating the
Juan B Ivey-Miranda1,2, Veena S Rao1, Zachary L Cox3,4
1Department of Internal Medicine, Section of Cardiovascular Medicine (J.B.I.-M., V.S.R., J.M.-V., D.M., C.M., L.B., J.M. Testani), Yale University School of Medicine, New Haven, CT.
Circulation. Heart Failure
|March 10, 2023
Summary
In-hospital observation on oral diuretics (OOD) for acute decompensated heart failure patients does not effectively guide discharge dosing or reduce readmissions. Further research is needed to optimize patient care and resource allocation.
Area of Science:
- Cardiology
- Clinical Pharmacology
- Health Services Research
Background:
- In-hospital observation on oral diuretics (OOD) is a recommended practice for acute decompensated heart failure (ADHF) patients.
- The assumption is that OOD provides actionable data for discharge diuretic dosing, aiming to reduce hospital readmissions.
Purpose of the Study:
- To evaluate the clinical utility of in-hospital OOD in ADHF patients.
- To determine if OOD provides actionable information for diuretic dose selection and impacts 30-day readmission rates.
Main Methods:
- Analysis of the Mechanisms of Diuretic Resistance (MDR) cohort for in-hospital diuretic response, provider decisions, and 30-day postdischarge response.
- Assessment of the Yale multicenter cohort to correlate in-hospital OOD with 30-day readmission risk.
Main Results:
- In the MDR cohort (N=468), OOD (57%) showed poor correlation between weight change and fluid balance (r=0.36).
- Discharge diuretic doses were similar regardless of weight change, fluid status, or urine output during OOD (P>0.27).
- In the Yale cohort (18,454 hospitalizations), OOD (55%) was not associated with 30-day readmission (HR, 0.98; P=0.51).
Conclusions:
- In-hospital OOD does not yield actionable diuretic response data.
- OOD is not associated with outpatient dose selection or prediction of subsequent diuretic response.
- The practice of in-hospital OOD did not demonstrate a reduction in 30-day hospital readmissions.
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