Abstract 11929: The Diuresis Clinic: A New Paradigm for the Treatment of Mild Decompensated Heart Failure
Background: Heart failure (HF) results in approximately one million hospital admissions annually in the United States and is the leading cause of 30-day readmissions. There is minimal data available on the outpatient treatment of heart failure with intravenous (IV) diuretics.
Methods: This study explores the impact of the Johns Hopkins Bayview Diuresis Clinic on outcomes and costs. Data was prospectively collected on all consecutive patients who received IV diuresis in the clinic from its establishment in October 2011 through December 2012 as well as a comparison cohort of HF patients admitted to the hospital for <48 hours. The percentage of hospitalized days was calculated for both cohorts 180 days prior to and up to 180 days after each patient’s index visit.
Results: In the diuresis clinic group, 106 patients (mean age 68.2 ± 13 years, 48% women) were treated over 328 visits (1 to 22 visits per person). Average visit duration was 220 minutes, with mean IV furosemide dose 100 mg, average urine output 1460 ± 730 ml, and weight loss 2.3 ± 1.8 kg. Average rate of hospitalization was 38 days per 1000 patient days prior to the index diuresis clinic visit compared to 28 days per 1000 patient days after the index visit (p < 0.0001). In the comparison group, 143 patients (mean age 69 ± 16 years, 54% women) were admitted for <48 hours. The average hospitalization rate increased from 14 to 21 per 1000 patient days after the index admission. The average total cost of each diuresis clinic visit was $642 (average professional fee $91; average cost for room, labs, pharmacy and EKG $551) which is substantially lower than the cost of one day of hospitalization (about $3,000), saving an estimated $912,310 per year for the patients seen in diuresis clinic.
Conclusion: Treatment of mild decompensated HF via a diuresis clinic cost-effectively reduced the subsequent rate of hospitalization as compared with treatment via a brief hospital stay, representing a unique strategy for the outpatient management of HF.
- © 2013 by American Heart Association, Inc.