Impact of oral diuretic monitoring duration prior to discharge on 30-day heart failure readmission rates

BACKGROUND: Current guidelines recommend transitioning patients with heart failure (HF) to oral diuretics prior to discharge, yet data guiding the optimal duration of oral diuretic monitoring remains limited. Prior retrospective studies assessed discharge-day oral diuretics or used a 24-hour monitoring cutoff. OBJECTIVES: This study aimed to evaluate time on oral diuretic prior to discharge and 30-day HF readmission. METHODS: This single center retrospective study included patients admitted for acute decompensated heart failure (ADHF) between 1/2020-9/2022. The primary end-point was 30-day HF readmission. Logistic regression models were used to estimate odds of readmission across varying durations of oral diuretic therapy (<24, 24-47, 48-71, and ≥72 h). Inverse propensity score weights (IPTW) were applied to control for confounder variables. Statistical significance was assessed using 95% confidence intervals (CI). RESULTS: A total of 466 patients were included (mean age 67.2 + 16.2 years; 56.2% male). IPTW results showed no significant difference in readmission rates for patients on diuretics < 24-hour group compared to 24-47 h (odds ratio (OR) 0.78 [95% confidence interval (CI) 0.36, 1.67], 48-71 h (OR 0.78 [CI 0.36, 1.69]), and ≥72 h (OR 0.99 [CI 0.45, 2.15]). There was no significant difference in readmission rates when comparing <24 h versus ≥24 h of oral diuretic therapy (OR 0.85 [CI 0.43, 1.68]). CONCLUSION: In patients with ADHF, extending oral diuretic monitoring beyond 24 h before discharge was not associated with reduced 30-day HF readmissions. Future studies should investigate the relationship between time on oral diuretics and overall response prior to discharge.