Ambulatory Intravenous Diuretic Clinic Associated with Short-Term Risk Reduction in Mortality and Rehospitalizations in Patients Discharged with Heart Failure.
R I Med J (2013)
Aged, Aged, 80 and over, Diuretics, Heart Failure, Hospitalization, Humans, Patient Discharge, Retrospective Studies, Risk Reduction Behavior, Stroke Volume, Ventricular Function, Left
BACKGROUND: Data on effectiveness of ambulatory intravenous (IV) diuretic clinics for volume management in patients with heart failure to prevent rehospitalization and mortality are limited. Therefore, the primary goal of this research is to evaluate the effectiveness of an out- patient multidisciplinary IV diuretic clinic versus standard observational hospitalizations of less than 48 hours for decompensated heart failure on the time to rehospitalization or death.
METHODS: A retrospective cohort study of patients with heart failure (n=90) at the Providence Veterans Affairs Medical Center was conducted. Patients were included in the analyses if they received at least one ambulatory IV diuretic clinic visit or an observational hospitalization of less than 48 hours for decompensated heart failure between January 1, 2014 and June 30, 2016. Using Cox proportional hazards modeling, we compared the time to any hospitalization or death between the IV clinic and the observational hospitalization cohort over 180 days of follow-up.
RESULTS: In the ambulatory IV diuretic clinic group, 27 patients (mean age 78.3 ± 8.3 years) received a median of 3 (interquartile range [IQR] 2-12), IV diuretic treatments. In the comparison group, 63 patients (mean age 80.3 ± 11.0 years) were hospitalized for observation for 48 hours or less during the same time period. Adjusting for age and imbalances in baseline characteristics, left ventricular ejection fraction and enrollment in hospice care, the hazards of any hospitalization or death (HR 0.39, 95% confidence interval 0.19 to 0.83) were reduced for patients in the ambulatory IV diuretic clinic versus those in the observational hospitalization cohort.
CONCLUSIONS: In patients with decompensated heart failure, an ambulatory IV diuretic clinic was associated with risk reduction of any rehospitalization or death over 180 days of follow up when compared to a strategy of observational hospitalization for less than 48 hours. Future research should prospectively analyze outpatient IV therapy in a larger and more diverse population.
St Amand A, Taveira TH, Henthorne KE, Wu WC. Ambulatory Intravenous Diuretic Clinic Associated with Short-Term Risk Reduction in Mortality and Rehospitalizations in Patients Discharged with Heart Failure. R I Med J (2013). 2020;103(9):16-21. Published 2020 Nov 2.