Abstract 15387: Outpatient Intravenous Diuresis for Acute Exacerbation of Heart Failure: A Claims-Based Analysis

Abstract

Introduction There is evidence that selected patients with HF exacerbation can be treated with outpatient IV diuresis (OIVD), delaying or avoiding subsequent acute care services and reducing cost. Hypothesis In selected HF patients, OIVD reduces or delays hospitalization and lowers medical cost. Methods Retrospective claims analysis using the Truven Market Scan database of medical and pharmacy claims (200 million USA lives). We identified all patients with claims for HF (Oct 2015- Sept 2022) receiving OIVD within 12 months after HF diagnosis.OIVD was administered as single day or multiple days events (OIVD over 10-day window). Care episodes and cost within 12 months after initiation of OIVD were defined by location of care: Hospital, ER, Observation, Skilled Nursing Facilities (SNFS) Outpatient Clinics. Results Out of 924,174 patients (age 63.4; SD 14.8) with an ICD 10 for HF, 42,132 received OIVD in hospital clinics, other clinics, physician's offices andER/Observation. One OVID episode was documented in 37,178; multipe in 4,954 (1.4-1.5 episodes per patient). After initiation of OVID, 33,172 patients required care for HF in ER, Observation, Hospital and SNFS (average of 5.9 events per patient). Hospitalization and SNFS were delayed by a mean of 4.60 months from OIVD. The remaing 8,960 patients did not require subsequent acute care or SNFS services for HF. The cost per OIVD episode was higher for ER and Observation (range $952 -$1730) than for outpatient clinics (range $190 -$ 786). The cost of hospitalization ranged $14,500-$57,488. Conclusions In selected patients with HF, OIVD is effective in delaying or preventing use of acute care services and it is associated with cost avoidance. New care protocols are needed to expand the use of OIVD in outpatient clinics and even in the home as an alternative to ER/Observation/Inpatient.