Abstract
Background: Among patients hospitalized for heart failure, a prior randomized trial suggests the initial dose of diuretics may have implications on time to decongestion and length of hospital stay. Little is known about the dosing of intravenous loop diuretics in routine clinical practice and the association between diuretic dosing and hospital length of stay. Methods: We identified 12,209 patients admitted with heart failure at 12 Allina Health hospitals in central Minnesota and western Wisconsin between January 1, 2017 and December 31, 2020. We excluded patients on observational status, no or unknown home loop diuretic dosing, no intravenous loop diuretic within 24 hours of admission, and patients who received inotropes or dialysis within 24 hours of admission. Initial diuretic dose was compared to home dose in furosemide equivalents using the Diuretic Strategies in Patients with Acute Decompensated Heart Failure trial logic and categorized into below home dose, equivalent to home dose, or above home dose. We describe patient characteristics and length of stay by category of initial diuretic dose. Results: Among 3,580 admitted for heart failure, initial diuretic dose was below home dose in 555 (15%) patients, equivalent to home dose in 756 (21%) patients, and above home dose in 2269 (64%) patients. Baseline characteristics by category of initial diuretic dose are presented in the Table. Mean length of stay was longest in patients receiving a diuretic dose that was below home dose (6.4 days) and shortest in patients receiving a dose above home equivalent (5.0 days) (Table). Conclusions: In a cohort of patients admitted for heart failure, more than 1 in 3 patients received an initial dose of intravenous loop diuretics that was equivalent to or below their home diuretic dose and this was associated with a longer length of hospital stay. These findings may represent a quality improvement opportunity in the care of patients hospitalized for heart failure.
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