Evaluation of the efficiency of at least 24-hour observation of transition to oral diuretic therapy before discharge on 30-day outcomes in acute heart failure patients: a comparative systematic review and meta-analysis

BACKGROUND: Acute heart failure (AHF) patients face high risks of readmission and mortality post-discharge. Transitioning from intravenous (IV) to oral (PO) diuretics before discharge is recommended to improve patient stability. However, the effectiveness of a prolonged observation period on oral diuretics (> 24 h) before discharge is still unclear. OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the effects of an extended (at least 24 h) oral diuretic response observation period prior to discharge on 30-day outcomes, including mortality, rehospitalization, and length of stay in patients with acute heart failure (AHF). METHODS: A comprehensive literature search was conducted across multiple databases, including PubMed/Medline, Embase, and Cochrane, up to November 2024. The study followed the PRISMA guidelines and was registered with PROSPERO (CRD42024608663). Seven retrospective observational studies involving 14,417 AHF patients were included. The Newcastle-Ottawa Quality Assessment Scale was applied to assess the risk of bias. RESULTS: The meta-analysis found no significant reduction in mortality (OR: 0.85; 95% CI [0.53-1.36]) or heart failure re-admissions (OR: 0.99; 95% CI[0.93-1.05]) for patients observed for at least 24 h after oral diuretic transition compared to those with shorter or no observation. All-cause readmission outcomes also showed no significant difference (OR: 1.02; 95% CI [0.71-1.47]). However, a longer LOS was observed in patients with extended observation (mean difference: 2.14 days; 95% CI [1.26-3.03]). CONCLUSION: Extended, at least 24-hour observation after the transition to oral diuretics therapy was significantly associated with an increased LOS but not an improvement in 30-day mortality or readmission rates in AHF patients.