Why the study?
Pharmacologic management of HFpEF involves far fewer options with demonstrated benefit, prompting evaluation of the effect of combining multiple HF medication classes on 30-day readmission.
Do specific heart failure medication classes at discharge reduce 30-day hospital readmission in patients with HFpEF?
Do specific heart failure medication classes at discharge reduce 30-day hospital readmission in patients with HFpEF?
Prescription of loop diuretics at discharge is associated with a reduced risk of early 30-day hospital readmission in patients with HFpEF.
Answers are grounded in this paper and cite their sources.
Multi-drug HF regimens may associate with lower 30-day readmission in HFpEF; leaves open need for randomized trials before practice change.
Background: The pharmacologic management of heart failure with preserved ejection fraction (HFpEF) involves far fewer options with demonstrated additional benefit. Therefore, we examined the effect of combination of multiple classes of HF medication in the 30-day hospital readmission in patients with HFpEF. Methods: All adult patients discharged with a diagnosis of HFpEF and a left ventricular ejection fraction (LVEF) of ≥ 50% reported during the admission or within the previous six months from our institution were retrospectively studied for a 30-day hospital readmission risk. Individual as well as combination drug therapy at the time of hospital discharge were evaluated using Pearson chi2 test and multivariate logistic regression. Results: The overall 30-day readmission rate in this HFpEF cohort of 445 discharges was 29%. Therapy with loop diuretics (p = 0.011), loop diuretics and angiotensin receptor blocker (p = 0.043) and loop diuretics and beta blockers (p = 0.049) were associated with a lower risk of 30-day hospital readmission. Multivariate logistic regression revealed only loop diuretics to be associated with a lower risk of hospital readmission in patients with HFpEF (OR 0.59; 95% CI, 0.39-0.90; p = 0.013). Conclusions: Our study revealed that loop diuretics at discharge decreases early readmission in patients with HFpEF. Further, our study highlights the implication of a lack of guidelines and treatment challenges in HFpEF patients and emphasizes the importance of a conservative approach in preventing early readmission in patients with HFpEF.
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Parajuli et al. (2020) studied this question.
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