HEART FAILURE SUPPORTIVE CARE CLINIC: DOES IT IMPROVE QUALITY OF LIFE?

Abstract

OBJECTIVE: Intravenous administration of loop diuretics is a cornerstone of therapy for acute decompensated heart failure (ADHF). Best practices to achieve safe, efficient fluid loss are dependent on appropriate monitoring and then adequate responses including diuretic dose adjustment and electrolyte correction. Our objective was to evaluate real-world practices for furosemide administration during the first 48 hours of admission for ADHF at our academic institution and to identify areas for quality improvement. We assessed the adequacy of weight monitoring, the relationship to drug administration, and practices to monitor and replace potassium. METHODS: Retrospective single center electronic chart review was conducted of hospitalized ADHF patients treated with intravenous furosemide from the time of admission. Patients who died or were discharged within 48 hours of starting furosemide were excluded. Demographics, length of stay and clinical data from the first 48 hours of admission were collected. RESULTS: We identified 402 unique episodes of care for ADHF between February 2010 and November 2012. Twenty-seven percent of patients had a baseline weight recorded within 12 hours of admission. The median time to first recorded weight after admission was 19 hours. The median total number of weights obtained in the first 48 hours was 1. Fifty-nine percent of patients had less than 2 weights recorded within 48 hours of admission. The mean furosemide dose administered over 48 hours was (163 128 mg). There was no difference in average furosemide dose between patients with and without baseline weight. However, patients who had less than 2 weights received significantly less furosemide (145 120 mg) compared to patients who had 2 or more weights (188 160 mg) (p1⁄40.007) over 48 hours. There was no significant difference in the median length of stay between patients who had less than two weights (8 days) versus those had 2 or more weights over 48 hours (7 days). All patients had a baseline and a repeat potassium measurement within 48 hours. Forty-two percent of patients presented with a baseline potassium <4 mmol/L, and 40% of those patients were administered replacement. CONCLUSION: Sizable proportions of patients were not weighed in a timely fashion, or lacked sufficient documentation to evaluate weight loss after furosemide administration. This appeared related to the total dose of furosemide received early on during admission. Practices for monitoring serum potassium were better, though replacement was less systematic. We identified several targets for quality improvement in the care of ADHF at our center. 281 HEART FAILURE SUPPORTIVE CARE CLINIC: DOES IT IMPROVE QUALITY OF LIFE?