Rapid Diuresis Protocol Reduces Hospital Stay In Acute Heart Failure Without Increasing 30-day Adverse Outcomes

Document Type

Conference Proceeding

Publication Date

2025

Publication Title

Journal of Cardiac Failure

Abstract

Introduction: Despite advancements in acute decompensated heart failure (ADHF) treatment, hospital length-of-stay (LOS) has remained stagnant over the past two decades. Loop diuretics are essential in managing ADHF, however there is a paucity of guidelines regarding optimal dosing. Current guidelines also recommend establishing congestion relief prior to discharge. In response to this gap, recent studies have begun to investigate the benefits of intensified diuresis strategies. This study evaluates our institution's Rapid Diuresis Treatment Protocol (RDT), a novel approach combining aggressive diuresis, strict monitoring inpatient with a continuous rounding concept, then continued outpatient decongestion and its impact on LOS, hospital opportunity days (LOS-CMS determined geometric length of stay), and 30-day adverse events.

Hypothesis: The RDT protocol significantly reduces the LOS in patients with ADHF without increasing the risk of AKI or other 30-day adverse outcomes.

Methods: This retrospective, single-center study evaluated hospitalized ADHF patients treated from March 2022 to November 2023, comparing the RDT protocol against standard care. We collected demographic, clinical, and laboratory data during hospitalization and within 30 days after discharge. The RDT protocol was compared to the standard of care using standard parametric and non-parametric methods, including Kaplan-Meier curve analysis for time-to-event data.

Results: The total study consisted of 128 patients in the RDT arm compared to 127 patients receiving standard of care for ADHF. RDT patients had a lower average LOS (3 days vs 6 days; p < 0.01), and experienced an average reduction of 2.1 opportunity days compared to standard care (p < 0.01). In the RDT arm, LOS was reduced without an increase in the incidence of AKI (RDT: 38 patients vs. standard care: 40 patients; p = 0.59), 30-day readmissions (p = 0.48), or mortality (p = 0.99), indicating no significant increase in adverse outcomes.

Conclusion: The RDT protocol significantly decreases LOS for patients with ADHF without increasing the risk of short-term AKI, mortality, or other adverse events. This suggests it is an effective and safe approach for improving ADHF care and reducing hospital costs.

Volume

31

Issue

1

First Page

223

Comments

Heart Failure Society of America (HFSA) Annual Scientific Meeting, September 27-30, 2024, Atlanta, GA

Frederik Meijer Heart & Vascular Institute

Last Page

224

DOI

10.1016/j.cardfail.2024.10.112

ISSN

1532-8414

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