Key result
In-hospital observation on oral diuretics shows no link to lower 30-day readmissions.
Why the study?
In-hospital observation on oral diuretics (OOD) after acute decompensated heart failure is recommended based on assumptions that it informs discharge dosing and reduces readmissions, but its utility remains unproven.
Does in-hospital observation on oral diuretics reduce 30-day hospital readmission in patients treated for acute decompensated heart failure?
Cohort (n=18,922)
Yes
Does in-hospital observation on oral diuretics reduce 30-day hospital readmission in patients treated for acute decompensated heart failure?
Hazard Ratio: 0.98 (95% CI 0.93–1.05)
p-value: p=0.51
In-hospital observation on oral diuretics does not provide actionable information or lower readmission risk, questioning the utility of guideline recommendations that mandate it and potentially contributing to unnecessary hospitalization days.
In-hospital observation on oral diuretics was not associated with lower 30-day readmissions; challenges recommendations but remains hypothesis-generating pending randomized trials.
Background: Following treatment for acute decompensated heart failure, in-hospital observation on oral diuretics (OOD) is recommended, assuming it provides actionable information on discharge diuretic dosing and thus reduces readmissions. Methods: In the Mechanisms of Diuretic Resistance (MDR) cohort, we analyzed in-hospital measures of diuretic response, provider’s decisions, and diuretic response ≈30 days postdischarge. In a Yale multicenter cohort, we assessed if in-hospital OOD was associated with 30-day readmission risk. The main objective of this study was to evaluate the utility of in-hospital OOD. Results: Of the 468 patients in the MDR cohort, 57% (N=265) underwent in-hospital OOD. During the OOD, weight change and net fluid balance correlated poorly with each other ( r =0.36). Discharge diuretic dosing was similar between patients who had increased, stable, or decreased weight (decreased discharge dose from OOD dose in 77% versus 72% versus 70%, respectively), net fluid status (decreased discharge dose from OOD dose in 100% versus 69% versus 74%, respectively), and urine output (decreased discharge dose from OOD dose in 69% versus 79% versus 72%, respectively) during the 24-hour OOD period ( P >0.27 for all). In participants returning at 30 days for formal quantification of outpatient diuretic response (n=98), outpatient and inpatient OOD natriuresis was poorly correlated ( r =0.26). In the Yale multicenter cohort (n=18 454 hospitalizations), OOD occurred in 55% and was not associated with 30-day hospital readmission (hazard ratio, 0.98 [95% CI, 0.93–1.05]; P =0.51). Conclusions: In-hospital OOD did not provide actionable information on diuretic response, was not associated with outpatient dose selection, did not predict subsequent outpatient diuretic response, and was not associated with lower readmission rate. Additional research is needed to replicate these findings and understand if these resources could be better allocated elsewhere. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02546583.
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Ivey‐Miranda et al. (2023) conducted a cohort in Acute decompensated heart failure (n=18,922). In-hospital observation on oral diuretics (OOD) vs. No in-hospital observation on oral diuretics was evaluated on 30-day hospital readmission (HR 0.98, 95% CI 0.93-1.05, p=0.51). In-hospital observation on oral diuretics was not associated with a lower risk of 30-day hospital readmission (HR 0.98, p=0.51).
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