Eur J Heart Fail. 2022 Oct 4. doi: 10.1002/ejhf.2708. Online ahead of print.
ABSTRACT
BACKGROUND: Acute heart failure (AHF) can be a life-threatening medical condition. Delaying administration of intravenous furosemide (time-to-diuretics) has been postulated to increase mortality, but prior reports have been inconclusive.
OBJECTIVE: To evaluate the association between time-to-diuretics and mortality in the international REPORT-HF registry.
METHODS: We assessed the association of time-to-diuretics within the first 24-hours with in-hospital and 30-day post-discharge mortality in 15,078 patients from 7 world-regions in the REPORT-HF registry. We further tested for effect modification by baseline mortality risk (ADHERE risk-score), left ventricular ejection fraction (LVEF) and region.
RESULTS: The median time-to-diuretics was 67 (25th -75th percentiles 17-190) minutes. Women, patients with more signs and symptoms of heart failure, and patients from Eastern Europe or Southeast Asia had shorter time-to-diuretics. There was no significant association between time-to-diuretics and in-hospital mortality (P>0.1). The 30-day mortality risk increased linearly with longer time-to-diuretics (administered between hospital arrival and 8-hours post- hospital arrival) (P=0.016). This increase was more significant in patients with a higher ADHERE risk score (Pinteraction =0.008), and not modified by LVEF or geographic region (Pinteraction >0.1 for both).
CONCLUSION: In REPORT-HF, longer time-to-diuretics was not associated with higher in-hospital mortality. However, we did found an association with increased 30-day mortality, particularly in high-risk patients, and irrespective of LVEF or geographic region. This article is protected by copyright. All rights reserved.
PMID:36196060 | DOI:10.1002/ejhf.2708