Key result
Pre-discharge transition to oral diuretics shows no benefit over continuing IV for 30-day HFrEF readmissions.
Why the study?
Current heart failure guidelines recommend transitioning IV diuretics to oral over 24 hours prior to hospital discharge, but whether this transition improves 30-day events in decompensated systolic heart failure was unknown.
Does transition to oral diuretics prior to discharge improve 30-day readmission and survival in patients hospitalized with decompensated systolic heart failure?
Cohort (n=314)
No
Does transition to oral diuretics prior to discharge improve 30-day readmission and survival in patients hospitalized with decompensated systolic heart failure?
Absolute Event Rate: 18.5% vs 19.9%
p-value: p=0.76
Transitioning patients with decompensated systolic heart failure to oral diuretics for a full day prior to discharge increases length of stay without improving 30-day readmission or survival rates.
Background: Current heart failure guidelines recommend transition of intravenous (IV) diuretics to oral > 24 h prior to hospital discharge. The aim of this study was to determine whether transition to oral diuretics prior to discharge in patients hospitalized with decompensated systolic heart failure (SHF) was associated with improved 30-day events. Methods: This was a retrospective cohort study, in which adults admitted to the Loma Linda Medical Center for 3 - 14 days with a primary discharge diagnosis of acute on chronic SHF were included. Mortality data were obtained from the National Death Index, while readmission only to our facility was included. The t -test and Chi-square test were used for analyses. Results: A total of 314 patients were studied. Patients who were managed with guideline-recommended trial of oral diuretics, and patients who continued to receive IV diuretics on the last full hospital day were overall similar in baseline characteristics. Patients who received oral diuretics on the day prior to discharge had longer length of stay, less weight loss, were discharged on lower diuretic doses (all P < 0.05), and had similar outcomes of 30-day readmission and 30-day hospitalization-free survival. Conclusions: The transition to oral diuretics prior to discharge in patients with decompensated SHF was not associated with improved 30-day outcomes. These results require validation in prospective trials but suggest that guideline recommendations regarding transitioning to oral diuretics prior to discharge may deserve re-evaluation. Cardiol Res. 2021;12(4):244-250 doi: https://doi.org/10.14740/cr1265
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Mohammad et al. (2021) conducted a cohort in Decompensated systolic heart failure (n=314). Oral diuretics vs. Intravenous diuretics was evaluated on 30-day any readmission (p=0.76). Transitioning to oral diuretics prior to discharge in patients with decompensated systolic heart failure did not significantly improve 30-day readmission rates compared to continuing intravenous diuretics.
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