IMPACT OF DOOR-TO-FUROSEMIDE TIME ON CLINICAL OUTCOMES IN PATIENTS WITH ACUTE HEART FAILURE

Abstract

BACKGROUND Rapid diagnosis and initiation of therapeutic interventions is a quality measure in acute heart failure (AHF) care. However, the impact of earlier treatment is unclear. We examined the association between door-to-furosemide (D2F) time and clinical outcomes in patients presenting to hospital with AHF. METHODS AND RESULTS CAN-HF is a Canadian multi-centre, retrospective, observational study of patients hospitalized with AHF. Patients age 18 and above with AHF in seven sites between January 2017 and April 2020 who received intravenous furosemide within 58 hours of presentation were included. D2F time was defined as the time from patient arrival at the emergency department to the first intravenous furosemide injection. Patients were stratified according to tertiles of D2F time. 551 patients met the inclusion criteria. The overall median D2F time was 207 minutes (interquartile range [IQR]: 104 to 361), with shorter median D2F time in community hospitals compared to tertiary centres (182 vs 217 minutes; p < 0.01). Median D2F times (in minutes) in the first, second and third tertiles were: 75 (IQR: 45 to 102), 204 (IQR: 166 to 242), and 435 (IQR: 359 to 607). Baseline characteristics were similar between the groups. There were no significant differences between groups in median hospital length of stay (respectively 6 [IQR: 4 to 11], 7 [IQR: 4 to 12] and 7 [IQR: 4 to 11] days; p = 0.75) and in-hospital mortality (respectively 7.2%, 7.7%, and 4.8%; p = 0.49). In a multivariable Poisson regression model, adjusting for baseline characteristics, D2F was not significantly associated with in-hospital death (odds ratio -0.07, 95% confidence interval -0.17 to 0.01) or length of stay (Figure 1). There was no relationship between D2F times and change in renal function during hospitalization (% of patients with a decrease in creatinine from admission to discharge: tertile 1, 30.1%; tertile 2, 32.4%; tertile 3, 34.4%; p = 0.73). Rates of non-invasive ventilation or intubation were significantly higher in the earliest D2F group (tertile 1, 16.0%; tertile 2, 4.4%; tertile 3, 2.7%; p < 0.01). CONCLUSION In this multicentre observational cohort study of patients presenting to hospital with AHF, D2F time was not associated with hospital length of stay, change in renal function, or in-hospital mortality. Rapid diagnosis and initiation of therapeutic interventions is a quality measure in acute heart failure (AHF) care. However, the impact of earlier treatment is unclear. We examined the association between door-to-furosemide (D2F) time and clinical outcomes in patients presenting to hospital with AHF. CAN-HF is a Canadian multi-centre, retrospective, observational study of patients hospitalized with AHF. Patients age 18 and above with AHF in seven sites between January 2017 and April 2020 who received intravenous furosemide within 58 hours of presentation were included. D2F time was defined as the time from patient arrival at the emergency department to the first intravenous furosemide injection. Patients were stratified according to tertiles of D2F time. 551 patients met the inclusion criteria. The overall median D2F time was 207 minutes (interquartile range [IQR]: 104 to 361), with shorter median D2F time in community hospitals compared to tertiary centres (182 vs 217 minutes; p < 0.01). Median D2F times (in minutes) in the first, second and third tertiles were: 75 (IQR: 45 to 102), 204 (IQR: 166 to 242), and 435 (IQR: 359 to 607). Baseline characteristics were similar between the groups. There were no significant differences between groups in median hospital length of stay (respectively 6 [IQR: 4 to 11], 7 [IQR: 4 to 12] and 7 [IQR: 4 to 11] days; p = 0.75) and in-hospital mortality (respectively 7.2%, 7.7%, and 4.8%; p = 0.49). In a multivariable Poisson regression model, adjusting for baseline characteristics, D2F was not significantly associated with in-hospital death (odds ratio -0.07, 95% confidence interval -0.17 to 0.01) or length of stay (Figure 1). There was no relationship between D2F times and change in renal function during hospitalization (% of patients with a decrease in creatinine from admission to discharge: tertile 1, 30.1%; tertile 2, 32.4%; tertile 3, 34.4%; p = 0.73). Rates of non-invasive ventilation or intubation were significantly higher in the earliest D2F group (tertile 1, 16.0%; tertile 2, 4.4%; tertile 3, 2.7%; p < 0.01). In this multicentre observational cohort study of patients presenting to hospital with AHF, D2F time was not associated with hospital length of stay, change in renal function, or in-hospital mortality.