Am J Cardiol. 2020 Dec 4:S0002-9149(20)31303-5. doi: 10.1016/j.amjcard.2020.11.041. Online ahead of print.
Acute heart failure (HF) management is a complex and often involves a delicate balance of both cardiac and renal systems. While pharmacologic diuresis is a mainstay of the pharmacologic management of decompensated HF, ultrafiltration (UF) represents a non-pharmacologic approach in the setting of diuretic resistance. We conducted a cross-sectional analysis of the 2009 through 2014 hospitalization data from the National Inpatient Sample. The study population consisted of hospitalizations with a discharge Diagnosis Related Groups of HF who were older than 18 years of age, did not have end-stage kidney disease, acute kidney injury and had not undergone hemodialysis or hemofiltration. There were 6,174 hospitalizations which included UF among the 7,799,915 hospitalizations for HF. Hospitalizations which included UF were among patients significantly younger in age (68.1±1.0 versus (vs) 73.8±0.1 years), male (61.9% vs 47.7%), and with higher prevalence of comorbid conditions including chronic kidney disease (58% vs 31%), diabetes mellitus (53% vs 42%), and higher rates of comorbidity (Charlson comorbidity score ≥ 2, 92% vs 80%). All-cause mortality was significantly higher among hospitalizations which included an UF (4.68% vs 2.24%). Hospitalizations with UF had a longer mean length of stay (6.2 vs 4.3 days, p<0.01) average total charges ($42,035 vs 24,867 USD, P<0.01) as compared to those without UF. Hospitalizations with UF were associated with a greater adjusted odds of all-cause mortality (OR: 3.36, [95% CI: 1.76,6.40]), greater than DRG-level target length of stay (OR, 2.46; [95 CI: 1.65,3.67]), and a 72% increase in the average hospital charges. In conclusion, hospitalizations which included UF identified a subgroup of HF patients with more comorbid conditions who are at higher risk of mortality and increased resource burden in terms of length of stay and costs. These findings also highlight that the need for UF may identify patients who are most likely to benefit from a multidisciplinary cardiorenal approach to alter the trajectory of their disease.