The Impact of Discharged Loop Diuretic Dose to Home Dose on Hospital Readmissions in Patients with Acute Decompensated Heart Failure: A Retrospective Cohort Study

Authors

  • Mohannad Alshibani, Pharm.D, BCPS Faculty of Pharmacy, Department of Pharmacy Practice, King Abdulaziz University, Jeddah, Saudi Arabia
  • Samah Alshehri, Pharm.D, MS, BCPS Faculty of Pharmacy, Department of Pharmacy Practice, King Abdulaziz University, Jeddah, Saudi Arabia
  • Wejdan Alyazidi, Pharm.D Candidate Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
  • Asmaa Alnomani, Pharm.D Candidate Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
  • Ziyad Almatruk, Pharm.D Faculty of Pharmacy, Department of Pharmacy Practice, King Abdulaziz University, Jeddah, Saudi Arabia
  • Tahani Almeleebia, Pharm.D, BCPS, BCACP College of Pharmacy, Department of Clinical Pharmacy, King Khalid University, Abha, Saudi Arabia

DOI:

https://doi.org/10.1532/hsf.3029

Keywords:

ADHF; Loop diuretics; Hospital Readmission; Ejection fraction; HFrEF

Abstract

Background: Acute decompensated heart failure (ADHF) is associated with a high rate of hospital readmission. The aim of this study is to examine the effect of the discharge diuretic dose compared with the home diuretic dose on hospital readmission in patients with ADHF.

Methods: A single center retrospective cohort study included patients with a confirmed diagnosis of ADHF with an ejection fraction of less than 40%. The sample was divided in two groups. The first group received a total daily discharge diuretic dose that was greater than the home dose; the second group received a daily discharge diuretic that was equal to or less than the home dose. The primary outcome was all-cause 30-day readmission rate. The secondary outcomes were all-cause 60-day and 90-day readmission rates.

Results: A total of 206 patients met inclusion criteria; 117 patients received a higher loop diuretic dose at discharge, while 89 were discharged with a loop diuretic that was equal to or less than the home dose. Patients in the increased-dose group had an all-cause 30-day readmission rate of 20.5% compared with 37.1% of patients with equal or reduced-dose group; P = .007. Additionally, there were lower readmission rates in 60 and 90 days between the increased and equal or reduced groups (33.3% versus 52.8%,
P < .017, and 41.0% versus 62.9%, P < .003, respectively.

Conclusions: Among patients admitted to hospital with ADHF and reduced ejection fraction, a discharge loop diuretic dose higher than the home dose was associated with decreased all-cause 30-day, 60-day, and 90-day readmission rates.

References

Arab News. 2018. http://www.arabnews.com/node/1259916/saudi-arabia.

Brater D, Day B, Burdette A, Anderson S. 1984. Bumetanide and furosemide in heart failure. Kidney Int 26(2):183-9.

Brater DC. 2011. Update in diuretic therapy: clinical pharmacology. Semin Nephrol 31 (6):483-94.

Felker GM, Lee KL, Bull DA, et al. 2011. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med 364(9):797–805.

Fonarow GC, Stough G, Abraham WT, et al. 2007. Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure. A report from the OPTIMIZE-HF Registry. J Am Coll Cardiol 50(8):768–777.

Go AS, Mozaffarian D, Roger VL, et al. 2013. Heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation 127:e6–245.

Hasselblad V, Gattis Stough W, Shah MR, et al. 2007. Relation between dose of loop diuretics and outcomes in a heart failure population: results of the ESCAPE trial. Eur Heart J. 9(10):1064-1069.

Jovicic A, Holroyd-Leduc JM, Straus SE. 2006. Effects of self-management intervention on health outcomes of patients with heart failure: a systematic review of randomized controlled trials. BMC Cardiovasc Disord 6:43.

Kannel WB. 2000. Incidence and epidemiology of heart failure. Heart Fail Rev 5(2):167–73.

Kociol RD, Hammill BG, Fonarow GC, et al. 2010. Generalizability and longitudinal outcomes of a national heart failure clinical registry: Comparison of Acute Decompensated Heart Failure National Registry (ADHERE) and non-ADHERE Medicare beneficiaries. Am Heart J 160(5):885–92.

Krumholz HM, Merrill AR, Schone EM, et al. 2009. Patterns of hospital performance in acute myocardial infarction and heart failure 30-day mortality and readmission. Circ Cardiovasc Qual Outcomes 2(5):407–13.

MOH News 2013. https://www.moh.gov.sa/en/ministry/mediacenter/news/pages/news-2013-10-30-002.aspx.

Publication Committee for the VMAC Investigators. 2002. Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial. JAMA 287(12):1531-40.

U.S. Department of Health and Human Services. 2011. The Booming Dynamics of Aging: From Awareness to Action. The White House Conference on Aging. Washington, DC: U.S. Department of Health and Human Services.

Woodruff AE, Kelley AM, Hempel CA, Loeffler WJ, Echtenkamp CA, Hassan AK. 2016. Discharge Diuretic Dose and 30-day Readmission Rate in Acute Decompensated Heart Failure. Annals of Pharmacotherapy 50(6):437-45.

Yancy CW, Jessup M, Bozkurt B, et al. 2013. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 128:1810.

Published

2020-07-07

How to Cite

Alshibani, M., Alshehri, S., Alyazidi, W., Alnomani, A., Almatruk, Z., & Almeleebia, T. (2020). The Impact of Discharged Loop Diuretic Dose to Home Dose on Hospital Readmissions in Patients with Acute Decompensated Heart Failure: A Retrospective Cohort Study. The Heart Surgery Forum, 23(4), E470-E474. https://doi.org/10.1532/hsf.3029

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