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

Clinical guidelines emphasize the administration of intravenous loop diuretics to manage acute decompensated heart failure (ADHF) effectively. Faster administration of diuretics, a concept called door-to-diuretic (D2D) time, may be associated with reduced hospital stay, lower readmission rates, and improved mortality and morbidity outcomes. Despite its significance, the factors contributing to prolonged D2D time remain unclear. Our aim was to identify predictors of prolonged D2D time among patients with ADHF.

In this retrospective analysis, we examined electronic medical records of 198 patients (275 hospitalizations) admitted with ADHF to the emergency department and who received intravenous diuretics at a major academic medical center. Predictor variables were standardized using z scores, and multicollinearity was assessed using the variance inflation factor. Feature selection was performed using recursive feature elimination and Least Absolute Shrinkage and Selection Operator regression, followed by backward elimination to refine the final model. Logistic regression models were fitted for different D2D time thresholds (<60 minutes, <90 minutes, median), and bootstrap resampling was conducted to validate model stability.

The average D2D time was 328.56 minutes, with only n = 26 (12.6%) of patients receiving a diuretic within 90 minutes. The cohort was predominantly older (mean age, 71 years) and 57% male. Key predictors of prolonged D2D time included lower heart rate, respiratory rate, and diastolic blood pressure, as well as the absence of peripheral edema.

Identifying these predictors provides valuable insights into factors contributing to treatment delays in ADHF. Tailored interventions targeting these risk factors could improve clinical outcomes by ensuring timely diuretic administration.