Readmission rates after Acute Decompensated Heart Failure

Abstract

Introduction: Acute Decompensated Heart Failure (ADHF) is a major health concern worldwide. Ultrafiltration (UF) versus Conventional Diuretics (CD) in ADHF treatment has been studied in several trials with variable outcomes. Objective: To determine if UF is superior to CD in reducing readmissions after ADHF. Methods: MEDLINE was searched using PUBMED for potential studies. Total studies found=590, Total trials=34, Randomized control trials (RCT) = 9 were included (n=820, UF=403, CD =417). RevMan Version 5.3 Copenhagen was used for statistical analysis. Sensitivity analysis was done for heterogeneity. Results: Baseline characteristics were similar in both groups. Mean age was 66 years and 74% were males. Mean EF was 32.9%. Total of 188 patients were readmitted secondary to ADHF with 77 in UF group vs 111 in CD group; RR was 0.71 (95% CI, 0.49-1.02, p=0.07, I2=47%) . There was significantly reduced number of readmissions at 90 days 43 vs 67 in favor of UF; RR was 0.65 (95% CI, 0.47-0.90, P=0.01, I2= 0%). Fluid removal and weight change were significantly higher in UF compared to CD. Change in creatinine pre and post intervention and the number of acute kidney injury were similar in both groups. There was also no difference in the length of hospital stay. Hypotension was more common in UF group compared to CD group (24 vs 13, OR = 2.06, 95%CI = 0.98-4.32, P=0.06, I2=0%) but it was statistically insignificant. Major Adverse Cardiovascular Events (MACE) and mortality was also similar in both groups. Sensitivity analysis was done for heterogeneity and is reported using I2. Conclusions: In this meta-analysis, UF was associated with significantly reduced heart failure readmissions at 90 days and there was trend towards reduced cumulative hospital readmissions. There was no difference in renal outcomes, fluid removal, weight loss, MACE and length of hospital stay in either intervention group.