Door-to-Diuretic Time and Outcomes in Acute Heart Failure: A Scoping Review.

Area of Science:

• Cardiology
• Pharmacology
• Clinical Medicine

Background:

• Inadequate decongestion is a significant challenge in managing acute heart failure (HF).
• The concept of optimizing door-to-diuretic (D2D) time aims to improve patient outcomes, but existing trial evidence is inconsistent.

Purpose of the Study:

• To systematically review the literature on the impact of door-to-diuretic (D2D) or door-to-furosemide time on outcomes in acute heart failure patients.
• To evaluate early diuretic administration as a decongestive strategy in acute heart failure.

Main Methods:

• A scoping review was conducted using PRISMA-ScR guidelines.
• Searches of PubMed and Scopus databases (January 2015–November 2023) used terms like "door-to-diuretic time" and "acute heart failure decongestion".
• Early D2D was defined as intravenous diuretic administration within 30-120 minutes of arrival; 13 English-language articles were included.

Main Results:

• Early diuretic administration was linked to reduced in-hospital mortality and shorter hospital stays.
• Higher furosemide doses improved HF symptoms and reduced hospitalizations, despite transient renal function decline.
• Evidence regarding long-term mortality benefits from early diuretic use remains inconclusive.

Conclusions:

• Early diuretic administration in acute heart failure is a potentially effective and safe strategy, though overall outcome impact is mixed.
• Further large-scale pragmatic trials are warranted to investigate D2D time optimization.
• Future research should explore diuretic efficiency-guided dosing and combination therapy.