Predictors of Prolonged Time to Diuresis Among Patients With Acute Heart Failure: A Pilot Study

Area of Science:

• Cardiology
• Emergency Medicine
• Pharmacology

Background:

• Intravenous loop diuretics are crucial for managing acute decompensated heart failure (ADHF).
• Faster door-to-diuretic (D2D) times are linked to better patient outcomes.
• Factors influencing prolonged D2D times in ADHF patients are not well understood.

Purpose of the Study:

• To identify predictors of prolonged door-to-diuretic (D2D) time in patients with acute decompensated heart failure (ADHF).

Main Methods:

• Retrospective analysis of 198 patients (275 hospitalizations) with ADHF.
• Standardized predictor variables using z scores and assessed multicollinearity.
• Employed recursive feature elimination, LASSO regression, and backward elimination for feature selection.
• Utilized logistic regression models for various D2D time thresholds and bootstrap resampling for validation.

Main Results:

• The average D2D time was 328.56 minutes; only 12.6% received diuretics within 90 minutes.
• The patient cohort was older (mean age 71) and 57% male.
• Key predictors of prolonged D2D time included lower heart rate, respiratory rate, diastolic blood pressure, and absence of peripheral edema.

Conclusions:

• Predictors of delayed diuretic administration in ADHF were identified.
• Targeting identified risk factors may improve timely treatment and patient outcomes.