Inpatient versus outpatient intravenous diuresis for the acute exacerbation of chronic heart failure

International Journal of Cardiology: Heart & Vasculature

Paul A. Heidenreich¹  Sumitra Balasubramanian²  Wen-Chin Wu³  Kelly B. Ohlms⁴  Elma Djukic⁵  Ilia G. Halatchev⁶  Jay R. McDonald⁶ 

[1] Corresponding author at: Veterans Affairs St. Louis Health Care System, John Cochran Division, 915 North Grand Blvd, St. Louis, Missouri 63106, United States.;Warren Alpert Medical School, Brown University, Providence, Rhode Island, United States;Washington University School of Medicine, St. Louis, MO, United States;Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States;Veterans Affairs Providence Health Care System, Providence Medical Center, Providence, Rhode Island, United States;Veterans Affairs St. Louis Health Care System, John Cochran Division, St. Louis, MO, United States;

关键词: Heart failure;    Outcomes;    Diuresis;    Acute decompensated heart failure;    Emergency department;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: We established an IV outpatient diuresis (IVOiD) clinic and conducted a quality improvement project to evaluate safety, effectiveness and costs associated with outpatient versus inpatient diuresis for patients presenting with acute decompensated heart failure (ADHF) to the emergency department (ED). Methods: Patients who were clinically diagnosed with ADHF in the ED, but did not have high-risk features, were either diuresed in the hospital or in the outpatient IVOiD clinic. The dose of IV diuretic was based on their home maintenance diuretic dose. The outcomes measured were the effects of diuresis (urine output, weight, hemodynamic and laboratory abnormalities), 30–90 day readmissions, 30–90 day death and costs. Results: In total, 36 patients (22 inpatients and 14 outpatients) were studied. There were no significant differences in the baseline demographics between groups. The average inpatient stay was six days and the average IVOiD clinic days were 1.2. There was no significant difference in diuresis per day of treatment (1159 vs. 944 ml, p = 0.46). There was no significant difference in adverse outcomes, 30–90 day readmissions or 30–90 day deaths. There was a significantly lower cost in the IVOiD group compared to the inpatient group ($839.4 vs. $9895.7, p=<0.001). Conclusions: Outpatient IVOiD clinic diuresis may be a viable alternative to accepted clinical practice of inpatient diuresis for ADHF. Further studies are needed to validate this in a larger cohort and in different sites.

【 授权许可】

Unknown