Congestive Heart Failure Exacerbations and the Role of Urine Output Monitoring

Background Monitoring fluid status is considered the standard of care for many patients treated in the intensive care unit (ICU), but there is little data to support its utility outside of the ICU. Data linking urine output (UO) monitoring with shortened length of stay (LOS), specifically in non-ICU heart failure (HF) patients, is scarce. This study aimed to determine the relationship between the electronic medical record order to "monitor intake/output" and LOS in patients with HF exacerbation, the impact of consulting nephrology, and whether the timing of consultation would improve measured outcomes.   Methods A hundred and twelve patient records with a diagnosis of "exacerbated heart failure", including International Classification of Diseases (ICD) 10 codes of I50.23 (acute on chronic systolic HF), I50.33 (acute on chronic diastolic HF), I50.21 (acute systolic HF), I50.31 (acute diastolic HF), I50.43 (acute on chronic combined systolic and diastolic HF), and I50.41 (acute combined systolic and diastolic HF) from McLaren Macomb Hospital, Mount Clemens, Michigan were reviewed, and the following clinical outcomes were evaluated: presence of physician order to "monitor intake/output" within the electronic medical record, comorbidities, stage of chronic kidney disease (CKD), grade of diastolic dysfunction, New York Heart Association stages of HF, types of diuretics used, LOS, readmission within 30 days, follow-up, frequency of urine monitoring per patient, and if there was a nephrology consult at the time of presentation.   Results Seventy-one (63.4%) patients received urine monitoring every eight hours, and there were no statistically significant differences between physician-ordered monitoring and comorbidities, stages of CKD, diastolic dysfunction grade, LOS, or readmission rates. The mean LOS was slightly higher in patients with the physician's order.   Conclusions Neither UO monitoring nor consulting nephrology was shown to significantly affect LOS or readmission rates in non-ICU patients with exacerbation of HF. Different methods in estimating volume status (e.g., daily body weight measurements, noninvasive monitoring devices) may substantially affect outcomes, and future studies are needed. .