Abstract 11531: The Three-Legged Stool, Balancing Diuretics, Sodium and Fluid Intake in Heart Failure
Stable sodium and fluid intake balanced with consistent oral diuretic use is thought to minimize fluid retention and avoid heart failure (HF) hospitalization. However, these 3 factors are rarely examined together so we know little about how patients manage this self-care.
Purpose: To describe patterns of diuretic use with sodium and fluid intake in relation to readmission.
Methods: We enrolled 24 hospitalized HF patients in a longitudinal, observational pilot study. All (16 men, 11 Blacks, mean age 60, mean HF duration 4.8 years) were discharged on a loop diuretic after hospitalization for a HF exacerbation. Over 3-months, diuretic use was measured daily using the medication event monitoring system (MEMS®). Percentage of prescribed doses taken (% PDT) was calculated and standardized (0 no adherence to 1.0 perfect adherence, >1.0 extra doses) for each 2-week period. Every 2 weeks patients were called to assess diet and fluid intake. Dietary sodium was measured using a list of 24 high sodium foods (e.g., pizza, hot dogs). Validity of the measure was confirmed with formal 3-day dietary recall assessments (randomly chosen days, 2 weekdays and 1 weekend day, each month) performed on 5 participants by a registered dietitian. After in-person training on cup size, fluid intake was estimated in cups for each 2-week period. Clinical events (ED visits, hospital readmissions, death) were obtained from the electronic medical record and confirmed by self-report.
Results: Six (25%) were readmitted within 3 months; 2 of the 6 died before any diuretic data could be obtained. The remaining 4 readmissions were explainable with poor diuretic use usually coupled with high sodium and/or fluid intake. In the 18 patients not readmitted, few (n=4) managed all 3 factors simultaneously, but 14 were savvy in adjusting one or two factors, showing insight that was not evident in those readmitted. Some increased their diuretic use only when sodium and fluid intake were high and decreased diuretics again later.
Conclusion: Rigid guidelines regarding diuretic use, sodium and fluid intake fail to acknowledge patients’ abilities to balance these 3 factors. Promoting skill in balancing diuretic use, sodium and fluid intake may encourage expertise in self-care.
Author Disclosures: B. Riegel: Consultant/Advisory Board; Modest; Novartis. J. Hill: None. J. Wald: None. G. Knafl: None. M. Daus: None. I. Ciuffetelli: None. L. Basel-Brown: None.
- © 2016 by American Heart Association, Inc.