A Diuretic Protocol Increases Volume Removal and Reduces Readmissions Among Hospitalized Patients With Acute Decompensated Heart Failure

Jeffrey H. Barsuk*, Robert A. Gordon, Elaine R. Cohen, William G. Cotts, David Malkenson, Clyde W. Yancy, Mark V. Williams

*Corresponding author for this work

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Despite the widespread use of loop diuretics to treat acute decompensated heart failure (ADHF), robust data supporting their role and optimal dosing strategies are scarce. This analysis aimed to compare clinical outcomes of patients admitted with ADHF who received a diuretic dosing protocol with those who received the usual diuretic therapy. We performed an observational medical records review to compare the use of a nurse-driven diuretic dosing protocol with usual diuretic dosing for patients admitted with ADHF during a 1-year period. Using a propensity scoring model, comparisons were made between groups for total weight loss, length of stay (LOS), 30-day readmissions, in-hospital mortality, 30-day mortality, and acute kidney failure. Sixty-eight of the 596 patients admitted with ADHF during the study period received the diuretic protocol. Protocol use was associated with an additional 2.63-kg weight loss (P=.003) but a trend toward increased LOS compared with patients receiving usual care (P=.097). However, patients receiving the protocol had a significantly lower risk of 30-day readmission (odds ratio, 0.46, 95% confidence interval, 0.22-0.95). Protocol use was not associated with significant differences in kidney failure, inpatient mortality, or 30-day mortality. A diuretic dosing protocol for patients admitted with ADHF improves weight loss and may lower 30-day readmissions, at the cost of potentially increasing LOS.

Original languageEnglish (US)
Pages (from-to)53-60
Number of pages8
JournalCongestive Heart Failure
Volume19
Issue number2
DOIs
StatePublished - Mar 1 2013

Fingerprint

Diuretics
Heart Failure
Weight Loss
Length of Stay
Mortality
Sodium Potassium Chloride Symporter Inhibitors
Hospital Mortality
Acute Kidney Injury
Medical Records
Renal Insufficiency
Inpatients
Odds Ratio
Nurses
Confidence Intervals

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Emergency Medicine
  • Emergency

Cite this

Barsuk, Jeffrey H. ; Gordon, Robert A. ; Cohen, Elaine R. ; Cotts, William G. ; Malkenson, David ; Yancy, Clyde W. ; Williams, Mark V. / A Diuretic Protocol Increases Volume Removal and Reduces Readmissions Among Hospitalized Patients With Acute Decompensated Heart Failure. In: Congestive Heart Failure. 2013 ; Vol. 19, No. 2. pp. 53-60.
@article{d3ad9a282352486d8bfeceba945bb700,
title = "A Diuretic Protocol Increases Volume Removal and Reduces Readmissions Among Hospitalized Patients With Acute Decompensated Heart Failure",
abstract = "Despite the widespread use of loop diuretics to treat acute decompensated heart failure (ADHF), robust data supporting their role and optimal dosing strategies are scarce. This analysis aimed to compare clinical outcomes of patients admitted with ADHF who received a diuretic dosing protocol with those who received the usual diuretic therapy. We performed an observational medical records review to compare the use of a nurse-driven diuretic dosing protocol with usual diuretic dosing for patients admitted with ADHF during a 1-year period. Using a propensity scoring model, comparisons were made between groups for total weight loss, length of stay (LOS), 30-day readmissions, in-hospital mortality, 30-day mortality, and acute kidney failure. Sixty-eight of the 596 patients admitted with ADHF during the study period received the diuretic protocol. Protocol use was associated with an additional 2.63-kg weight loss (P=.003) but a trend toward increased LOS compared with patients receiving usual care (P=.097). However, patients receiving the protocol had a significantly lower risk of 30-day readmission (odds ratio, 0.46, 95{\%} confidence interval, 0.22-0.95). Protocol use was not associated with significant differences in kidney failure, inpatient mortality, or 30-day mortality. A diuretic dosing protocol for patients admitted with ADHF improves weight loss and may lower 30-day readmissions, at the cost of potentially increasing LOS.",
author = "Barsuk, {Jeffrey H.} and Gordon, {Robert A.} and Cohen, {Elaine R.} and Cotts, {William G.} and David Malkenson and Yancy, {Clyde W.} and Williams, {Mark V.}",
year = "2013",
month = "3",
day = "1",
doi = "10.1111/chf.12020",
language = "English (US)",
volume = "19",
pages = "53--60",
journal = "Prevention and Management of Congestive Heart Failure",
issn = "1527-5299",
publisher = "Wiley-Blackwell",
number = "2",

}

A Diuretic Protocol Increases Volume Removal and Reduces Readmissions Among Hospitalized Patients With Acute Decompensated Heart Failure. / Barsuk, Jeffrey H.; Gordon, Robert A.; Cohen, Elaine R.; Cotts, William G.; Malkenson, David; Yancy, Clyde W.; Williams, Mark V.

In: Congestive Heart Failure, Vol. 19, No. 2, 01.03.2013, p. 53-60.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A Diuretic Protocol Increases Volume Removal and Reduces Readmissions Among Hospitalized Patients With Acute Decompensated Heart Failure

AU - Barsuk, Jeffrey H.

AU - Gordon, Robert A.

AU - Cohen, Elaine R.

AU - Cotts, William G.

AU - Malkenson, David

AU - Yancy, Clyde W.

AU - Williams, Mark V.

PY - 2013/3/1

Y1 - 2013/3/1

N2 - Despite the widespread use of loop diuretics to treat acute decompensated heart failure (ADHF), robust data supporting their role and optimal dosing strategies are scarce. This analysis aimed to compare clinical outcomes of patients admitted with ADHF who received a diuretic dosing protocol with those who received the usual diuretic therapy. We performed an observational medical records review to compare the use of a nurse-driven diuretic dosing protocol with usual diuretic dosing for patients admitted with ADHF during a 1-year period. Using a propensity scoring model, comparisons were made between groups for total weight loss, length of stay (LOS), 30-day readmissions, in-hospital mortality, 30-day mortality, and acute kidney failure. Sixty-eight of the 596 patients admitted with ADHF during the study period received the diuretic protocol. Protocol use was associated with an additional 2.63-kg weight loss (P=.003) but a trend toward increased LOS compared with patients receiving usual care (P=.097). However, patients receiving the protocol had a significantly lower risk of 30-day readmission (odds ratio, 0.46, 95% confidence interval, 0.22-0.95). Protocol use was not associated with significant differences in kidney failure, inpatient mortality, or 30-day mortality. A diuretic dosing protocol for patients admitted with ADHF improves weight loss and may lower 30-day readmissions, at the cost of potentially increasing LOS.

AB - Despite the widespread use of loop diuretics to treat acute decompensated heart failure (ADHF), robust data supporting their role and optimal dosing strategies are scarce. This analysis aimed to compare clinical outcomes of patients admitted with ADHF who received a diuretic dosing protocol with those who received the usual diuretic therapy. We performed an observational medical records review to compare the use of a nurse-driven diuretic dosing protocol with usual diuretic dosing for patients admitted with ADHF during a 1-year period. Using a propensity scoring model, comparisons were made between groups for total weight loss, length of stay (LOS), 30-day readmissions, in-hospital mortality, 30-day mortality, and acute kidney failure. Sixty-eight of the 596 patients admitted with ADHF during the study period received the diuretic protocol. Protocol use was associated with an additional 2.63-kg weight loss (P=.003) but a trend toward increased LOS compared with patients receiving usual care (P=.097). However, patients receiving the protocol had a significantly lower risk of 30-day readmission (odds ratio, 0.46, 95% confidence interval, 0.22-0.95). Protocol use was not associated with significant differences in kidney failure, inpatient mortality, or 30-day mortality. A diuretic dosing protocol for patients admitted with ADHF improves weight loss and may lower 30-day readmissions, at the cost of potentially increasing LOS.

UR - http://www.scopus.com/inward/record.url?scp=84875671561&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84875671561&partnerID=8YFLogxK

U2 - 10.1111/chf.12020

DO - 10.1111/chf.12020

M3 - Article

C2 - 23336425

AN - SCOPUS:84875671561

VL - 19

SP - 53

EP - 60

JO - Prevention and Management of Congestive Heart Failure

JF - Prevention and Management of Congestive Heart Failure

SN - 1527-5299

IS - 2

ER -