Optimal Initial Intravenous Loop Diuretic Dosing in Acute Decompensated Heart Failure.

Area of Science:

• Cardiology
• Pharmacology
• Clinical Medicine

Background:

• Nearly half of acute decompensated heart failure (ADHF) patients are discharged with unresolved congestion, increasing rehospitalization risk.
• Suboptimal intravenous (IV) loop diuretic dosing may contribute to persistent congestion.
• Home oral diuretic dose may influence initial IV diuretic dosing strategies.

Purpose of the Study:

• To investigate the association between home oral loop diuretic dose and optimal initial IV loop diuretic dosing in ADHF patients.
• To determine if optimal initial IV loop diuretic dosing impacts length of stay and 30-day readmission rates.

Main Methods:

• Retrospective analysis of 3,269 adult ADHF patients on home oral loop diuretics (2014-2021).
• Patients categorized by home dose: low (≤40 mg), medium (>40-80 mg), and high (>80 mg) furosemide equivalents.
• Optimal initial IV dosing defined as ≥2 times home oral dose; Poisson regression used to analyze associations.

Main Results:

• Optimal initial IV dosing was achieved in 67.9% of patients.
• Prevalence of optimal IV dosing was highest in low home dose (95.5%), decreasing significantly with medium (59.9%) and high (4.0%) home doses.
• Higher home diuretic doses were strongly associated with a lower likelihood of receiving optimal initial IV dosing (High: aPR 0.05; Medium: aPR 0.66).
• No significant difference in length of stay or 30-day readmission was observed between optimal and suboptimal IV dosing groups.

Conclusions:

• Home loop diuretic dose is a critical factor influencing the administration of optimal initial IV diuretic therapy in ADHF.
• Current dosing strategies may not adequately account for home diuretic use, potentially leading to suboptimal treatment.
• Further research is needed to optimize IV diuretic protocols for ADHF patients based on their home oral diuretic regimen.