The Diuresis Clinic: A New Paradigm for the Treatment of Mild Decompensated Heart Failure.
Am J Med. 2015 Jan 7;
Authors: Makadia S, Simmons T, Augustine S, Kovell L, Harris C, Chibungu A, Parakh K
Abstract
BACKGROUND: Heart failure results in approximately one million hospital admissions annually in the United States and is the leading cause of 30-day readmissions.
METHODS: This study explores the impact of a diuresis clinic on heart failure outcomes and cost. Data was prospectively collected on all consecutive patients who received intravenous (IV) diuretics and multi-disciplinary care in the clinic from its establishment in October 2011 through December 2012 as well as a comparison cohort of heart failure patients admitted to the hospital for <48 hours. The percentage of hospitalized days was calculated for both cohorts 180 days prior to and 180 days after each patient's index visit.
RESULTS: In the diuresis clinic group, 106 patients (mean age 68.2±13 years, 48% women) were treated over 328 visits (1-22 visits per person), with mean IV furosemide dose 100 mg, average urine output 1460±730 ml, and weight loss 2.3±1.8 kg. Days hospitalized decreased from 38.3 to 31.2 per 1,000 patient-days after the index diuresis clinic visit (p<0.01). In the comparison group, 143 patients (mean age 69±16 years, 54% women) were admitted for <48 hours. Days hospitalized increased from 14.4 to 21.0 per 1,000 patient-days after index admission (p<0.01). On multivariate analysis, diuresis clinic was associated with three fewer days in the hospital per 180 days per patient, with an estimated annual savings of $12,113 per patient.
CONCLUSION: Compared with a brief hospital stay, treatment of mild decompensated heart failure in a diuresis clinic resulted in a substantial and cost-effective decline in the rate of subsequent hospitalization.
PMID: 25576670 [PubMed - as supplied by publisher]