Why the study?
Does an increase in loop diuretic dose at discharge reduce all-cause 30-day readmission in patients with acute decompensated heart failure and reduced ejection fraction?
Does an increase in loop diuretic dose at discharge reduce all-cause 30-day readmission in patients with acute decompensated heart failure and reduced ejection fraction?
Increasing the discharge dose of loop diuretics relative to preadmission doses in patients with acute decompensated heart failure and reduced ejection fraction is associated with a significant reduction in 30-day all-cause readmissions.
Increasing loop diuretic dose at discharge was associated with lower readmissions in ADHF; leaves open whether this warrants practice change pending RCTs.
BACKGROUND: Loop diuretics play a crucial role in symptom management in patients with fluid overload. There is a paucity of data regarding optimal diuretic dose at hospital discharge for acute decompensated heart failure (ADHF) patients requiring loop diuretics. OBJECTIVE: To compare all-cause 30-day readmission in ADHF patients on chronic loop diuretics who had an increase in loop diuretic dose at discharge (relative to their preadmission dose) with patients without a change or a decrease in loop diuretic dose at discharge. METHODS: This was a multicenter, retrospective cohort study. Institutional review board approval was obtained. Patients admitted with a primary discharge diagnosis of heart failure, evidence of fluid overload, and reduced ejection fraction were included. Patients were divided into 2 groups based on total daily loop diuretic dose at discharge: those discharged on an increased dose and those discharged on a dose less than or equal to their preadmission dose. RESULTS: A total of 131 patient admissions met inclusion criteria; 50 had an increase in loop diuretic dose at discharge, and 81 were discharged with no change or a decrease in diuretic dose. Patients in the increased dose group had an all-cause 30-day readmission rate of 20% compared with 38% of patients with no change or a decrease in diuretic dose (adjusted odds ratio = 0.320; 95% CI = 0.117-0.873). CONCLUSION: In patients admitted for ADHF with reduced ejection fraction and evidence of fluid overload, an increase in loop diuretic dose at discharge was associated with a reduced rate of 30-day hospital readmission.
No takes yet. Share an insight, caveat, or question.
Woodruff et al. (2016) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: