Abstract 14044: Association Between Home Diuretic Dose and Optimal Initial Intravenous Diuretic Dosing in Acute Decompensated Heart Failure

Abstract

Introduction: Nearly half of adults admitted with acute decompensated heart failure (ADHF) are discharged with a patient-reported or objective physical evidence of unrelieved congestion, which increases the re-hospitalization risk. This may be due to suboptimal initial intravenous (IV) loop diuretic dosing upon admission, which is often based on a patient’s home diuretic regimen. Methods: We performed a cross-sectional analysis of adults admitted to a large, quaternary healthcare system for ADHF between Jan. 1, 2014 and Dec. 21, 2021 to determine the association between oral home loop diuretic dose and receiving optimal initial IV dosing, as well as receiving optimal initial IV dosing and hospital length of stay (LOS). Patients were categorized based on home oral loop diuretic dose: low (≤40 mg furosemide equivalents [FEs]) and high (>40 mg FEs). We defined optimal initial IV dosing at least twice the home oral diuretic dose. Multivariable Poisson regression models estimated prevalence ratios (PRs) and confidence intervals (CIs) for the association between home oral diuretic dose and receiving optimal initial IV diuretic dosing. Results: Among 3,269 adults (mean age 63 years, 62% male, 82% non-Hispanic White, 51.7% ejection fraction ≤40%, mean home oral diuretic dose 71.8 mg FEs) admitted for ADHF, optimal initial IV loop diuretic dosing occurred in 2,218 (67.9%) patients. Optimal initial IV diuretic dosing was more likely to occur among patients on a low (95.5%) vs. high home dose (35.9%; PR 0.46; 95% CI 0.42-0.50). Among those who were on low oral home diuretic doses, LOS was decreased in those who received optimal initial IV dosing (estimate 0.84; 95% CI 0.77-0.91; P<0.001). Conclusion: Despite loop diuretics being the primary initial therapy for ADHF, there is significant heterogeneity in practice patterns. Understanding why clinicians use suboptimal doses and patients who are at risk of undertreatment may improve outcomes for patients admitted with ADHF.