Skip to main content
release_alert
Welcome to the new Scholars 3.0! Read about new features and let us know what you think.
cancel
Journal cover image

Early diuretic strategies and the association with In-hospital and Post-discharge outcomes in acute heart failure.

Publication ,  Journal Article
Fudim, M; Spates, T; Sun, J-L; Kittipibul, V; Testani, JM; Starling, RC; Tang, WHW; Hernandez, AF; Felker, GM; O'Connor, CM; Mentz, RJ
Published in: Am Heart J
September 2021

BACKGROUND: Decongestion is a primary goal during hospitalizations for decompensated heart failure (HF). However, data surrounding the preferred route and strategy of diuretic administration are limited with varying results in prior studies. METHODS: This is a retrospective analysis using patients from ASCEND-HF with a stable diuretic strategy in the first 24 hours following randomization. Patients were divided into three groups: intravenous (IV) continuous, IV bolus and oral strategy. Baseline characteristics, in-hospital outcomes, 30-day composite cardiovascular mortality or HF rehospitalization and 180-day all-cause mortality were compared across groups. Inverse propensity weighted modeling was used for adjustment. RESULTS: Among 5,738 patients with a stable diuretic regimen in the first 24 hours (80% of overall ASCEND trial), 3,944 (68.7%) patients received IV intermittent bolus administration of diuretics, 799 (13.9%) patients received IV continuous therapy and 995 (17.3%) patients with oral administration. Patients in the IV continuous group had a higher baseline creatinine (IV continuous 1.4 [1.1-1.7]; intermittent bolus 1.2 [1.0-1.6]; oral 1.2 [1.0-1.4] mg/dL; P <0.001) and high NTproBNP (IV continuous 5,216 [2,599-11,603]; intermittent bolus 4,944 [2,339-9,970]; oral 3,344 [1,570-7,077] pg/mL; P <0.001). There was no difference between IV continuous and intermittent bolus group in weight change, total urine output and change in renal function till 10 days/discharge (adjusted P >0.05 for all). There was no difference in 30 day mortality and HF readmission (adjusted OR 1.08 [95%CI: 0.74, 1.57]; P = 0.701) and 180 days mortality (adjusted OR 1.04 [95%CI: 0.75, 1.43]; P = 0.832). CONCLUSION: In a large cohort of patients with decompensated HF, there were no significant differences in diuretic-related in-hospital, or post-discharge outcomes between IV continuous and intermittent bolus administration. Tailoring appropriate diuretic strategy to different states of acute HF and congestion phenotypes needs to be further investigated.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

September 2021

Volume

239

Start / End Page

110 / 119

Location

United States

Related Subject Headings

  • United States
  • Time-to-Treatment
  • Peptide Fragments
  • Patient Readmission
  • Outcome and Process Assessment, Health Care
  • Natriuretic Peptide, Brain
  • Mortality
  • Middle Aged
  • Male
  • Injections, Intravenous
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Fudim, M., Spates, T., Sun, J.-L., Kittipibul, V., Testani, J. M., Starling, R. C., … Mentz, R. J. (2021). Early diuretic strategies and the association with In-hospital and Post-discharge outcomes in acute heart failure. Am Heart J, 239, 110–119. https://doi.org/10.1016/j.ahj.2021.05.011
Fudim, Marat, Toi Spates, Jie-Lena Sun, Veraprapas Kittipibul, Jeffrey M. Testani, Randall C. Starling, WH Wilson Tang, et al. “Early diuretic strategies and the association with In-hospital and Post-discharge outcomes in acute heart failure.Am Heart J 239 (September 2021): 110–19. https://doi.org/10.1016/j.ahj.2021.05.011.
Fudim M, Spates T, Sun J-L, Kittipibul V, Testani JM, Starling RC, et al. Early diuretic strategies and the association with In-hospital and Post-discharge outcomes in acute heart failure. Am Heart J. 2021 Sep;239:110–9.
Fudim, Marat, et al. “Early diuretic strategies and the association with In-hospital and Post-discharge outcomes in acute heart failure.Am Heart J, vol. 239, Sept. 2021, pp. 110–19. Pubmed, doi:10.1016/j.ahj.2021.05.011.
Fudim M, Spates T, Sun J-L, Kittipibul V, Testani JM, Starling RC, Tang WHW, Hernandez AF, Felker GM, O’Connor CM, Mentz RJ. Early diuretic strategies and the association with In-hospital and Post-discharge outcomes in acute heart failure. Am Heart J. 2021 Sep;239:110–119.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

September 2021

Volume

239

Start / End Page

110 / 119

Location

United States

Related Subject Headings

  • United States
  • Time-to-Treatment
  • Peptide Fragments
  • Patient Readmission
  • Outcome and Process Assessment, Health Care
  • Natriuretic Peptide, Brain
  • Mortality
  • Middle Aged
  • Male
  • Injections, Intravenous