The Role of a Titrated Diuresis Protocol in Acute Decompensated Heart Failure

Document Type

Conference Proceeding

Publication Date

4-2026

Publication Title

Journal of the American College of Cardiology

Abstract

Background: Acute Decompensated Heart Failure (ADHF) accounts for over one million annual hospitalizations. While IV loop diuretics are standard therapy, dosing strategies remain variable. Nurse driven titration protocols may enhance efficiency and outcomes. This study assessed the impact of a titratable IV furosemide protocol (TIFP) on length of stay (LOS) and secondary outcomes.

Methods: We retrospectively studied 1,279 patients ADHF at Corewell Health Butterworth Hospital, of whom 900 received TIFP and 379 standard care (SC). The protocol permitted incremental titration of IV furosemide by nursing staff based on urine output. Data included demographics, diuretic dosing, fluid balance, laboratory monitoring, mortality and morbidity factors and LOS. Propensity matching was used to remove potential bias between groups from covariates.

Results: Protocol adherence was 71.6% (goal ≥70%). Median LOS was significantly lower with TIFP vs SC (4.28 [2.89-6.79] vs 5.16 [3.23-8.18] days, p < 0.01), reflecting a 15.4% reduction (p < 0.001). Hospital mortality, 30 day readmission, hypotension, electrolytes abnormalities, kidney injury and dialysis were not different between 2 groups. The time from IV diuresis to oral transition was lower in TIFP vs SC but not statistically significant (73.5 vs 83.63 hours, p = 0.08).

Conclusion: A nurse driven titratable IV furosemide protocol significantly reduced LOS without increasing complications supporting this strategy as a safe and effective in ADHF management.

Volume

87

Issue

13 Suppl

First Page

A586

Comments

American College of Cardiology 75th Annual Scientific Session & Expo, March 28-30, 2026, New Orleans, LA

Last Page

A587

DOI

10.1016/j.jacc.2026.02.1561

ISSN

0735-1097

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