Abstract
The role of intravenous hydration on hospital readmissions due to acute exacerbation of congestive heart failure (CHF) has not been studied sufficiently to the best of our knowledge. We sought to determine the possible role of intravenous hydration on hospital readmissions for acute CHF and fluid overload and explain how an intravenous fluid (IVF) restriction strategy may help reduce hospital readmission rates. We retrospectively studied the electronic medical records of 98-patient cohort who had hospital readmission due to acute decompensated congestive heart failure (ADHF) during the period of January 1, 2016 to July 9, 2016. These patients were admitted with reasons other than ADHF during the index admission. The patients were divided into two groups; those with ADHF readmissions within 15 days of index admission (group A) and those after 15 days (group B). Various factors affecting CHF readmissions as outlined in the results were compared between these two groups. Cohort of 98 patients (53 females, 54.1%; 76.4±11.6 years) re-admitted during the study period of 1/1/2016 to 7/9/2016 were analyzed. 71 patients had only received IVF during index admission. These were subdivided into group A (12 females, 54.5 %; mean age 75.9±12.9 years) and group B (25 females, 51.02%; mean age 76.08±11.90 years) based on readmission ≤15 days or >15 days from the index admission. There was no statistically significant difference (P=0.97) in amount of IVF prescribed between two subgroups but the duration of prescribed IVF significantly affected readmission in group A compared to group B (P=0.03). While the drop in albumin and rise in creatinine were not significant, the mean hemoglobin (Hb) drop in group A compared to group B was significant at P=0.008. Type of IVF and nature of CHF (heart failure with reduced ejection fraction, HFrEF/heart failure with preserved ejection fraction, HFpEF) were not found to significantly affect early readmissions associated with IV hydration. In patients with history of CHF, duration of IVF prescribed during the index admission seems to play important role in early CHF readmission (defined as <15 days in our study).
Highlights
Congestive heart failure (CHF) is a complex clinical syndrome that results from structural or functional impairment of ventricular filling or ejection of blood which in turn leads to cardinal symptoms of dyspnea, fatigue and signs of heart failure, namely edema and rales.[1]
Head-to-head comparison was done between amount, nature and duration of intravenous fluid (IVF) prescribed during the index admission; incidence of readmission based on type of heart failure defined as systolic, diastolic and combined
There were 22 patients in group A while 49 patients were in group B
Summary
Congestive heart failure (CHF) is a complex clinical syndrome that results from structural or functional impairment of ventricular filling or ejection of blood which in turn leads to cardinal symptoms of dyspnea, fatigue and signs of heart failure, namely edema and rales.[1]. 5 million patients with a diagnosis of CHF live in the US.[3] Those ≥65 years old account for more than 80% of deaths and prevalent cases related to CHF in the USA and Europe.[4] With improvement in life expectancy, higher survival rate after myocardial infarction and advent of medications like angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, beta blockers, aldosterone antagonist and electrical devices such as implantable cardioverter defibrillator, the odds of patients surviving with a diagnosis of CHF have increased significantly. Recent data suggest that 30-day readmission rates have surged up to 25% in the United States.[5] Notably, mortality in CHF is closely associated with ADHF requiring hospital admission, frequent admissions and early (60 days or less) readmissions.[6] Many predictors associated with readmission of patients with CHF have been recognized. Any readmission within 15 days of index admission has been defined as early re-admission in our study
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