Abstract 20613: Inadequate Loop Diuretic Dosing in Acute Heart Failure: A Missed Opportunity
Introduction: Loop diuretics are a mainstay of acute decompensated heart failure (ADHF) treatment in the Emergency Department (ED). Guidelines regarding the use of diuretics are variable, but most commonly include starting ED dosing at an equal or greater amount than the patient’s outpatient regimen, or giving ‘adequate amounts to achieve desired volume status’. The goal of this study was to characterize the variability of diuretic dosing in patients treated in the ED for recurrent ADHF in relationship to outpatient diuretic dose.
Methods: Data were derived from a prospective observational study of patients with prior HF on home diuretics who were diagnosed and treated for ADHF in an urban, tertiary care ED between 2011 and 2013. Patients were excluded if they had a triage systolic blood pressure (SBP) < 95mmHg or were on hemodialysis. Patients were stratified based on initial diuretic dosing in relation to home diuretic dose.
Results: Our study group of 247 patients had the following features: average age, initial creatinine, SBP, home diuretic dose, and ED length of stay were 75 years, 1.35 mg/dl, 140.3 mmHg, 78.1 ± 62 mg, and 8.9 hours respectively. 86% of patients received only one dose of diuretics in the ED within 6 hours of arrival. After stratification (Table) the majority of patients (60%) received an IV dose in the ED less than the home dose despite having findings of ADHF on x-ray in 72% of cases. Urine output varied predictably with increasing dose and was inversely related to creatinine.
Conclusion: This study demonstrates that the parenteral dosing of diuretics in the ED is often inadequate (based on guidelines) which represents a missed opportunity to facilitate early fluid decongestion. Patient reassessment also fell short as only 13% of patients received a second dose of diuretics despite long ED stays. In order to improve the initial care of patients with ADHF, research is needed to understand how to standardize care in the ED.
Author Disclosures: C.E. Darling: None. G. Zimmer: None. Y. Malyuta: None. D.D. McManus: None.
- © 2016 by American Heart Association, Inc.