Diuretic Efficiency in Acute Decompensated Heart Failure Patients is Associated with Greater Rates of Discharge Home After an Observation Unit Stay
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Emergency Medicine Investigations 04 (01): 4 (04 March 04 March, 2019)

Background: Acute Decompensated Heart Failure (ADHF) is a common Emergency Department Observation Unit (OU) disease. Diuretic efficiency is net fluid output produced per fixed dose of loop diuretic and patients with lower diuretic efficiency have worse outcomes. We evaluated if diuretic efficiency rates were associated with discharge home after ADHF treatment in an OU. Methods: We performed a retrospective study of 607 ADHF OU patients. Diuretic efficiency was defined as the net UOP per equivalent dose of 40 mg furosemide. Patients were stratified in quartiles by levels of diuretic efficiency and rates of discharge were compared with the Cochrane Armitage test. Results: In the final cohort of 607 patients, 309 (51%) were male and 325 (54%) were discharged after OU treatment. The median total diuretic dose was 80 mg furosemide (IQR 40-116 mg) and the median diuretic efficiency was 1.4L (IQR 0.85-2.3L). Quartiles arranged by decreasing diuretic efficiency demonstrated decreasing rates of discharge home Q1 63% (50-75%), Q2 58% (51-65%), Q3 53% (45-61%), Q4 44% (37-52%) which was statistically significant (P=0.023) Conclusion: In patients presenting to the OU with ADHF, increased diuretic efficiency is associated with higher incidence of discharge home versus admission to the hospital but was not associated with 30-day readmissions.
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