Document Type

Conference Proceeding

Publication Date

5-2024

Publication Title

Academic Emergency Medicine

Abstract

Background and Objectives: Congestive heart failure (CHF) is anticipated to affect eight million Americans by 2030. Treatment for CHF exacerbation is centered around IV diuretics. There are no current studies indicating an optimal initial diuretic dose in the Emergency Department (ED), and our objective is to test our hypothesis that higher diuretic dose ratio may shorten hospital length of stay (LOS). Methods: We conducted a retrospective cohort study of a large health system from 2016 to 2022. We included patients admitted from the ED with a primary diagnosis of “CHF exacerbation” with a history of CHF and prescribed diuretics. Exclusions include history of aortic stenosis, SBP < 90, need for inotropes/vasopressors, creatinine (Cr) >3, ESRD on dialysis, and missing medication data. We calculated an initial diuretic dose ratio by dividing the initial administered dose in the ED by the home diuretic dose. We then classified a patient's diuretic ratio as <2, 2–4, or >4. Primary outcome is hospital LOS and additional outcomes assessed include 30-day readmission, mortality, ICU admission, non-invasive ventilation (NIV) and acute kidney injury (AKI). Multivariable regression analysis was performed adjusting for age, sex, race, BMI, initial Cr, and Elixhauser Comorbidity Index. Results: There were 10,129 identified with initial query conditions of which 5668 were excluded, leaving 4661 for analysis. The cohort has a median age of 75.92 with 37.0% Black and 51.9% female. The LOS for patients receiving a ratio of >4 was nearly 7% lower than those receiving ratio <2 (Ln ratio −0.0719 [−0.13322 to −0.0115]; p= 0.0196). When comparing ratio 2–4 to <2, the LOS was lower but not significant. While the ratio >4 did have increased ICU and NIV, there were no significant differences in 30-day readmission, mortality, or AKI. Conclusion: This study is the first to show that using an initial ED diuretic dose ratio of >4 has significant reduction in hospital LOS, despite these patients requiring more NIV and ICU admissions.

Volume

31

Issue

S1

First Page

137

Comments

Society for Academic Emergency Medicine SAEM Annual Meeting, May 14-17, 2024, Phoenix, AZ

DOI

10.1111/acem.14533

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