Abstract 16430: Early Urine Sodium Response After Ambulatory Diuretic Bolus to Avoid Heart Failure Hospitalization
Introduction: Ambulatory heart failure management may increasingly include administration of intravenous diuretics in an outpatient setting, but it is difficult to know when response will be adequate to avoid hospitalization.
Hypothesis: We assessed whether a high initial urine sodium (Na) after an intravenous diuretic bolus would predict net urine output > 1 liter after 3 hours of diuretic infusion, performed in an ACTIVE (Ambulatory Cardiac Triage, InterVention, and Education) unit where a nurse and pharmacist also provided heart failure education.
Methods and Results: The unit accepted patients with chronic heart failure referred with symptomatic fluid overload without severe decompensation, and prescribed loop diuretic bolus and infusion dosed from an internal algorithm based on daily oral dose. Urine output was > 1 liter after 3 hours in 77% of patients with urine Na response > 100 mmol/L, in 69% with urine Na 61-100, and only 23% with initial urine Na < 60 mmol/L. Baseline renal function was better in patients with higher urine Na after diuretic therapy.
Conclusion: In conclusion, we can anticipate at least 1 liter diuresis in most patients with initial urine Na > 60 mmol/L after bolus diuretic. Patients with urine Na > 100 also have significantly lower 30 day ED and admission rates after outpatient diuretic infusion. Patients with low urine Na response may still have diuresis but may need more prolonged intervention or revision of goals of care.
Author Disclosures: L. Burpee: None. A. Desai: None. J. Smallwood: None. M. Young: None. L. Stevenson: None. I. Cooper: None. K. Navarro-Velez: None. E. Shea: None. C. Stevens: None. C. Weiffenbach: None. J. Weintraub: None. M. Mehra: None.
- © 2014 by American Heart Association, Inc.