Discharge Diuretic Dose and 30-Day Readmission Rate in Acute Decompensated Heart Failure.

Autor:	Woodruff AE; State University of New York at Buffalo, NY, USA Buffalo General Medical Center, Buffalo, NY, USA aew7@buffalo.edu., Kelley AM; Lebanon Veterans Affairs Medical Center, Lebanon, PA, USA., Hempel CA; State University of New York at Buffalo, NY, USA Buffalo General Medical Center, Buffalo, NY, USA., Loeffler WJ; Buffalo General Medical Center, Buffalo, NY, USA D'Youville College, Buffalo, NY, USA., Echtenkamp CA; Buffalo General Medical Center, Buffalo, NY, USA D'Youville College, Buffalo, NY, USA., Hassan AK; D'Youville College, Buffalo, NY, USA.
Jazyk:	angličtina
Zdroj:	The Annals of pharmacotherapy [Ann Pharmacother] 2016 Jun; Vol. 50 (6), pp. 437-45. Date of Electronic Publication: 2016 Mar 08.
DOI:	10.1177/1060028016637385
Abstrakt:	Background: Loop diuretics play a crucial role in symptom management in patients with fluid overload. There is a paucity of data regarding optimal diuretic dose at hospital discharge for acute decompensated heart failure (ADHF) patients requiring loop diuretics. Objective: To compare all-cause 30-day readmission in ADHF patients on chronic loop diuretics who had an increase in loop diuretic dose at discharge (relative to their preadmission dose) with patients without a change or a decrease in loop diuretic dose at discharge. Methods: This was a multicenter, retrospective cohort study. Institutional review board approval was obtained. Patients admitted with a primary discharge diagnosis of heart failure, evidence of fluid overload, and reduced ejection fraction were included. Patients were divided into 2 groups based on total daily loop diuretic dose at discharge: those discharged on an increased dose and those discharged on a dose less than or equal to their preadmission dose. Results: A total of 131 patient admissions met inclusion criteria; 50 had an increase in loop diuretic dose at discharge, and 81 were discharged with no change or a decrease in diuretic dose. Patients in the increased dose group had an all-cause 30-day readmission rate of 20% compared with 38% of patients with no change or a decrease in diuretic dose (adjusted odds ratio = 0.320; 95% CI = 0.117-0.873). Conclusion: In patients admitted for ADHF with reduced ejection fraction and evidence of fluid overload, an increase in loop diuretic dose at discharge was associated with a reduced rate of 30-day hospital readmission. (© The Author(s) 2016.)
Databáze:	MEDLINE
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