Effect of Door To Diuretic Time In Acute Heart Failure

Abstract

Introduction Heart failure is defined by the American Heart Association and American College of Cardiology as “a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood”. (1) Treatment of acute heart failure is by diuretics to get rid of excess fluid. There were two cohort studies done in Korea and Japan. The cohort study in Japan showed benefit of early diuretic initiation with respect to mortality in hospital (2), however the cohort study in Korea did not show any significance of early initiation of diuretics. As the studies were conflicting in their results, we devised a study to study effect of door to diuretic time on mortality, length of stay in hospital. Objective of the study is to find the association between door to diuretic time on the clinical outcome for the patients who presented to Emergency department. Methods Patients presenting with symptoms and signs of overload to well span hospitals in between January 2019 to June 2019 were included in this study. There were 944 patients who presented to hospital during this time period. Early and late diuretic group were respectively defined as door to diuretic time < 120 min and > 120 min Primary outcome of study is the inpatient mortality during the hospitalization, while the secondary outcome is the length of hospitalization and readmission. We used the get with the guideline heart failure risk score to ascertain the severity of heart failure at the time of presentation to Emergency. Results A total of 944 patients were evaluated. Based on timing of diuretic dosing 285 (30.2%) were given diuretics at 120 minutes or less and 659 (69.8%) patients were given diuretics at greater than 120 minutes. Outcomes associated with diuretic timing showed no difference for length of stay or readmission rate but there was a significant difference in mortality with 1.1% in those given diuretics at 120 minutes or less compared to 3.5% patients were given diuretics at greater than 120 minutes (p=0.041, see Table 1). Door to diuretic time greater than 120 minutes was associated with 3.4 fold increased risk of mortality. Heart failure is defined by the American Heart Association and American College of Cardiology as “a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood”. (1) Treatment of acute heart failure is by diuretics to get rid of excess fluid. There were two cohort studies done in Korea and Japan. The cohort study in Japan showed benefit of early diuretic initiation with respect to mortality in hospital (2), however the cohort study in Korea did not show any significance of early initiation of diuretics. As the studies were conflicting in their results, we devised a study to study effect of door to diuretic time on mortality, length of stay in hospital. Objective of the study is to find the association between door to diuretic time on the clinical outcome for the patients who presented to Emergency department. Patients presenting with symptoms and signs of overload to well span hospitals in between January 2019 to June 2019 were included in this study. There were 944 patients who presented to hospital during this time period. Early and late diuretic group were respectively defined as door to diuretic time < 120 min and > 120 min Primary outcome of study is the inpatient mortality during the hospitalization, while the secondary outcome is the length of hospitalization and readmission. We used the get with the guideline heart failure risk score to ascertain the severity of heart failure at the time of presentation to Emergency. A total of 944 patients were evaluated. Based on timing of diuretic dosing 285 (30.2%) were given diuretics at 120 minutes or less and 659 (69.8%) patients were given diuretics at greater than 120 minutes. Outcomes associated with diuretic timing showed no difference for length of stay or readmission rate but there was a significant difference in mortality with 1.1% in those given diuretics at 120 minutes or less compared to 3.5% patients were given diuretics at greater than 120 minutes (p=0.041, see Table 1). Door to diuretic time greater than 120 minutes was associated with 3.4 fold increased risk of mortality.