Abstract
Background: Among hospitalized heart failure patients with evidence of fluid overload, guidelines recommend prompt use of loop diuretics to reduce morbidity. Little is known about delays in the use of loop diuretics among patients with congestive heart failure admitted from an emergency department (ED). Methods: We identified 2,801 patients admitted via an ED with heart failure at 12 Allina Health hospitals between January 1, 2017 and December 31, 2020. We excluded patients on observational status, no or unknown home loop diuretic dosing, no intravenous (IV) loop diuretic within 24 hours of admission, on home thiazide-like or thiazide-type diuretic and patients who received inotropes or dialysis prior to admission or 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 diuretic use. Results: Among 2801 admitted for heart failure and receiving IV loop diuretics within 24 hours of admission, 1048 (37%) received no IV diuretic in the ED, the initial diuretic dose was below home dose in 346 (12%) patients, equivalent to home dose in 170 (6%) patients, and above home dose in 1237 (44%) patients. Baseline characteristics by category of initial diuretic dose are presented in the Table. Mean length of stay was longest in patients receiving no diuretic in the ED (4.99 days) and shortest in patients receiving a dose above home equivalent (4.48 days) (Table). Conclusions: In a cohort of patients admitted for heart failure, nearly a third of patients failed to receive an IV loop diuretic in the emergency department 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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