Role Of Ejection Fraction On Discharge Diuretic Dose And Cardiac Rehospitalizations

Abstract

<h3>Introduction</h3> Acute decompensated heart failure (ADHF) is one of the most common causes of hospitalizations in the United States - accounting for 57.4 million hospitalizations between 2001 and 2014. Patients discharged from the hospital for ADHF are prescribed oral loop diuretics to prevent signs and symptoms of volume overload. Currently, there is conflicting literature regarding home loop diuretic dose adjustments during hospitalizations. As a result, we sought to compare the effects of dose adjustments at discharge on clinical outcomes in both heart failure preserved ejection fraction (HFpEF) and heart failure reduced ejection fraction (HFrEF). <h3>Hypothesis</h3> Patients with lower ejection fractions will have a higher risk for rehospitalization at 60 days. <h3>Methods</h3> 2193 hospital encounters for ADHF in a WellSpan affiliated hospital in Pennsylvania between December 1, 2017 to January 1, 2020 were identified and included in this retrospective study. Baseline characteristics, rehospitalizations, and cardiac hospitalizations at 60 days were compared for patients with HFpEF and HFrEF using one-way ANOVA, chi-square tests, and linear regression. <h3>Results</h3> There were 831 HFrEF and 1362 HFpEF hospitalizations The average age for the cohort was 75.53 + 12.26 with a weight of 93.69 + 29.51 kg. Average discharge diuretic dose for HFrEF patients was 101 + 74.1 mg and 90.2 + 70.6 mg for HFpEF patients. There was a statistically significant difference between both cohorts in terms of brain-natriuretic peptide, baseline creatinine, CAD, HTN, and atrial fibrillation history. There was a significant correlation between decreasing diuretic dose and increased cardiac hospitalizations in the HFrEF cohort (p = 0.04), but not in the HFpEF population (p = 0.96) at 60 days. There was no association between dose adjustments at discharge with rehospitalizations at 60 days (p = 0.93), and cardiac hospitalizations at 60 days (p = 0.37). When combining both cohorts, there was a lack of significance with discharge diuretic dose adjustments with rehospitalizations (p = 0.40) and cardiac hospitalizations (p = 0.47) at 60 days. <h3>Conclusions</h3> Patients with HFrEF were more likely to have cardiac rehospitalizations compared to HFpEF patients with decreasing home diuretic doses at discharge at 60 days. Most likely, decreasing home diuretic dose at discharge results in an increased risk of volume overload. The reason for decreasing diuretic doses could include low blood pressures as well as increasing creatinine. Both variables have been shown to be independent predictors of poor outcomes in heart failure. Interestingly, the HFpEF patients did not have any changes in 60-day outcomes with changes in diuretic dosing. As a result, there may be other factors may be in play affecting cardiac rehospitalizations in patients with HFpEF moreso than symptoms of congestion.