Impact of Transitioning Patients to Oral Diuretics 24 Hours Before Discharge from Heart Failure Hospitalization on 30 Day Outcomes

Link to article at PubMed

Int J Cardiol. 2022 Jun 20:S0167-5273(22)00930-5. doi: 10.1016/j.ijcard.2022.06.030. Online ahead of print.

ABSTRACT

BACKGROUND: Patients hospitalized for heart failure (HF) are at high risk for post-discharge events. Although transition from intravenous to oral diuretics for >24 hours is commonly practiced to reduce post-discharge risk, evidence supporting this strategy is limited. We investigated the impact of this practice on 30 day post-discharge outcomes following HF hospitalization at our institution.

METHODS: Retrospective chart review of patients hospitalized with a primary HF diagnosis, discharged on oral diuretic, and followed at our institution. Admission, in-hospital, and pre-discharge characteristics of patients discharged with >24-hour observation were compared to those of patients observed for <24-hours on oral diuretics. Differences between groups in composite 30 day all-cause mortality and rehospitalization, each component, and HF rehospitalization were assessed.

RESULTS: Of 285 patients meeting entry criteria, 178 received oral diuretics >24 hours prior to discharge and 107 were discharged <24 hours after transitioning to oral diuretics. Baseline characteristics were similar between groups. Patients with >24 hours observation on oral diuretics had longer in-hospital stays and greater weight and net volume loss than those observed <24 hours. Patients receiving oral diuretics for <24 hours were more likely to have had neurohormonal drugs and diuretic dose changed within 24-hours of discharge. Oral diuretic treatment for >24 hours failed to reduce any study endpoint.

CONCLUSIONS: Transitioning patients to oral diuretics for >24 hours prior to discharge following HF hospitalization failed to improve 30-day outcomes. These results question this strategy for all patients hospitalized for worsening HF.

PMID:35738415 | DOI:10.1016/j.ijcard.2022.06.030

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