Initial higher-than-home dose loop diuretics in heart failure patients increased acute kidney injury risk by 17% but reduced 30-day readmission by 15%; lower doses lengthened stay.
Does a higher initial dose of intravenous loop diuretics relative to home dose improve outcomes in patients hospitalized for heart failure?
In patients hospitalized for heart failure, administering an initial IV loop diuretic dose higher than the patient's home dose is associated with a shorter length of stay and lower 30-day readmission risk, albeit with a higher risk of acute kidney injury.
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Background Little is known about the initial dosing of loop diuretics among patients hospitalized for heart failure and its association with outcomes. Methods We identified patients admitted for heart failure at 24 hospitals across two health systems between January 1, 2017, and December 31, 2020. Initial diuretic dose was categorized relative to home dose in furosemide equivalents. The primary outcomes (length of stay) and secondary outcomes (rates of acute kidney injury, in‐hospital mortality, and 30‐day readmissions) were compared across categories of initial diuretic dose. Results Among 14 332 patients admitted for heart failure, the initial diuretic dose was lower‐than‐home dose in 1866 (13.0%) patients, equivalent‐to‐home dose in 3171 (22.1%) patients, and higher‐than‐home dose in 9295 (64.9%) patients. Compared with patients who received an equivalent or higher initial diuretic dose relative to home dose, risk‐adjusted length of stay was longer among patients receiving a lower dose (4.9 days versus 4.0 days versus 4.0 days, P <0.01). Compared with equivalent‐to‐home dose, a higher initial diuretic dose was associated with a higher risk‐adjusted rate of acute kidney injury (incident risk ratio IRR, 1.17 95% CI 1.04–1.31; P =0.009) and a lower risk of 30‐day readmission (IRR, 0.85 95% CI, 0.78–0.93; P =0.005). Conclusions In a cohort of patients admitted for heart failure, more than 1 in 3 patients received an initial dose of intravenous loop diuretics that was lower than or equivalent to their home diuretic dose, and the initial dose was associated with length of hospital stay and acute kidney injury.
Qadri et al. (Fri,) reported a other. Initial higher-than-home dose loop diuretics in heart failure patients increased acute kidney injury risk by 17% but reduced 30-day readmission by 15%; lower doses lengthened stay.