P3534Optimal dosing of initial bolus of intravenous furosemide in acute heart failure: insights from REALITY-AHF

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Matsue ◽  
T Okumura ◽  
K Kida ◽  
S Oishi ◽  
E Akiyama ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Stay ◽  
Acute Heart Failure ◽  
Dose Group ◽  
Standard Dose ◽  
Length Of Hospital Stay ◽  
Loop Diuretics ◽  
Recommended Dose ◽  
Diuretic Response ◽  
Initial Bolus

Abstract Background Although intravenous diuretics are a cornerstone in the treatment of patients with acute heart failure (AHF), optimal dosing of initial bolus of IV diuretics has not been well elucidated. Methods The initial IV bolus dose of furosemide and its association with outcomes were analyzed in 1290 AHF patients (median age, 81 years, 55% were male) derived from REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure). The patients were divided into 3 groups; lower dose (lower than recommended dose, n=371), standard dose (same as recommended dose, n=807), and higher dose (higher than recommended dose, n=112) groups according to the recommended initial IV bolus furosemide dose derived from the maintenance loop diuretics dose (for those without taking oral loop diuretics or taking ≤40mg/day oral furosemide-equivalent loop diuretics, 20mg IV bolus furosemide; those on >40mg/day oral furosemide-equivalent loop diuretics, IV bolus furosemide at the same dose as oral loop diuretic dose). Outcomes were length of hospital stay, diuretic response (urine output achieved within 48 hours of admission per 40 mg furosemide-equivalent diuretics dose), and 60-day all-cause mortality. Results Median amount of first IV bolus furosemide dose were 10, 20, and 40 mg for lower, standard, and higher dose groups, respectively. After adjustment for other covariates, length of hospital stay was significantly longer by 2.6 days (p=0.018) in the lower dose group compared to the standard dose group, and there was no difference between the standard and high dose groups (p=0.221). Diuretic response within 48 hours of admission was significantly better in the lower dose group (beta coefficient: 244 mL, p=0.025) and significantly worse in the higher dose group (beta coefficient: - 1098 mL, p<0.001) compared to the standard dose group after adjustment for covariates. During 60 days of admission, 91 deaths were observed, and 60-day mortality was significantly higher in the higher dose group (HR: 2.80, 95% CI: 1.49–5.26, p=0.001), but not in the lower dose group (HR: 1.18, 95% CI: 0.67–2.08, p=0.571) compared to the standard dose group after adjustment for other prognostic factors. Conclusion Treatment with the recommended initial bolus of IV furosemide is associated with a shorter hospital stay compared to lower dose regimen and better diuretic response and better 60-day survival compared to higher dose regimen in patients with AHF. Acknowledgement/Funding This study was funded by The Cardiovascular Research Fund, Tokyo, Japan.

Length of hospital stay and its impact on subsequent early readmission in patients with acute heart failure: a report from the WET-HF Registry

2019 ◽  
Vol 34 (11) ◽  
pp. 1777-1788 ◽  
Author(s):  
Hidenori Moriyama ◽  
◽  
Takashi Kohno ◽  
Shun Kohsaka ◽  
Yasuyuki Shiraishi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Stay ◽  
Acute Heart Failure ◽  
Length Of Hospital Stay ◽  
Early Readmission

scholarly journals Loop Diuretic Administration in Patients with Acute Heart Failure and Reduced Systolic Function: Effects of Different Intravenous Diuretic Doses and Diuretic Response Measurements

2019 ◽  
Vol 8 (11) ◽  
pp. 1854
Author(s):  
Gaetano Ruocco ◽  
Mauro Feola ◽  
Ranuccio Nuti ◽  
Lorenzo Luschi ◽  
Isabella Evangelista ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Poor Prognosis ◽  
Dose Group ◽  
Loop Diuretic ◽  
Systolic Function ◽  
Multivariable Analysis ◽  
High Dose ◽  
Diuretic Response ◽  
Infusion Period

Background: Despite the fact that loop diuretics are a landmark in acute heart failure (AHF) treatment, few trials exist that evaluate whether the duration and timing of their administration and drug amount affect outcome. In this study, we sought to evaluate different loop diuretic infusion doses in relation to outcome and to diuretic response (DR), which was serially measured during hospitalization. Methods: This is a post-hoc analysis of a DIUR-HF trial. We divided our sample on the basis of intravenous diuretic dose during hospitalization. Patients taking less than 125 mg of intravenous furosemide (median value) were included in the low dose group (LD), patients with a diuretic amount above this threshold were inserted in the high dose group (HD). The DR formula was defined as weight loss/40 mg daily of furosemide and it was measured during the first 24 h, 72 h, and over the whole infusion period. Outcome was considered as death due to cardiovascular causes or heart failure hospitalization. Results: One hundred and twenty-one AHF patients with reduced ejection fractions (EF) were evaluated. The cardiovascular (CV) death/heart failure (HF) re-hospitalization rate was significantly higher in the HD group compared to the LD group (75% vs. 22%; p < 0.001). Both low DR, measured during the entire infusion period (HR 3.25 (CI: 1.92–5.50); p < 0.001) and the intravenous diuretic HD (HR 5.43 [CI: 2.82–10.45]; p < 0.001) were related to outcome occurrence. Multivariable analysis showed that DR (HR 3.01 (1.36–6.65); p = 0.006), intravenous diuretic HD (HR 2.83 (1.24–6.42); p=0.01) and worsening renal function (WRF) (HR 2.21 (1.14–4.28); p = 0.01) were related to poor prognosis. Conclusions: HD intravenous loop diuretic administration is associated with poor prognosis and less DR. Low DR measured during the whole intravenous administration better predicts outcome compared to DR measured in the early phases. ClinicalTrials.gov Acronym and Identifier Number: DIUR-HF; NCT01441245; registered on 23 September 2011.

Differences between Continuous Infusion and Intermittent Bolus of Furosemide with Length of Hospital Stay in Patients with Acute Heart Failure in Haji Adam Malik General Hospital Medan

2020 ◽  
Vol 6 (1) ◽  
pp. 9-15
Author(s):  
Imam Kukuh Darmawan ◽  
Zainal Safri ◽  
Refli Hasan ◽  
Harris Hasan ◽  
Zulfikri Mukhtar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Stay ◽  
Continuous Infusion ◽  
Acute Heart Failure ◽  
Length Of Hospital Stay ◽  
Controlled Study ◽  
Duration Of Treatment ◽  
Continuous Administration ◽  
Intermittent Bolus ◽  
Urine Production

Background: Heart failure is a complication that often occurs in individuals with or without underlying cardiovascular disease. Furosemide serves to reduce preload and improve congestion symptoms. The aim of this study was to determine the difference in length of hospital stay between continuous infusion and intermittent bolus of furosemide in patients with acute heart failure.Methods: This study was a prospective-single blind-randomized controlled study of 54 people with acute heart failure who entered the emergency room and underwent treatment at the H. Adam Malik Hospital from October 2018 to March 2019. Re-examination of urine production, kidney function, and electrolytes was carried out after 72 hours of treatment. Subsequent subjects were observed during treatment for death during treatment and duration of treatment. Follow-up was carried out for 30-days to assess rehospitalization.Results: Between continuous infusion group and intermittent bolus group, we found, respectively, length of hospital stay 7.6±3.2 vs. 7.3±4.8 days, p=0.28; urine production 2241±429 vs 2020±368, p=0.048; ∆BUN 3.6 ± 14.5 vs 4.0 ± 10.9, p=0.91; ∆Ureum 7.9 ± 31.0 vs 8.5 ± 23.3; p=0.92; ∆Creatinine 0.1 ± 0.61 vs. 0.03 ± 0.33; p=0.56; and ∆GFR -5.5 ± 20.6 vs -2.7 ± 22.7; p=0.64. In terms of mortality during hospitalization, we found that 7.4% vs 11.1%, p=0.63 (HR 0.64; 95% CI: 0.098–4.1) and rehospitalization in 30 days showed 22.2% vs 37%; p=0.23 (HR 0.48; 95% CI: 0.14–1.6) in continuous infusion vs. intermittent bolus group, respectively.Conclusions: In patients with acute heart failure, there is no difference between continuous infusion and intermittent bolus of furosemide in regard to length of hospital stay, changes in renal function and electrolyte, death during hospitalization, and rehospitalization within 30-days. However, continuous administration of furosemide infusion is better in urine production.

scholarly journals Predictors and Associations With Outcomes of Length of Hospital Stay in Patients With Acute Heart Failure: Results From VERITAS

2016 ◽  
Vol 22 (10) ◽  
pp. 815-822 ◽  
Author(s):  
Gad Cotter ◽  
Beth A. Davison ◽  
Olga Milo ◽  
Robert C. Bourge ◽  
John G.F. Cleland ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Stay ◽  
Acute Heart Failure ◽  
Length Of Hospital Stay

scholarly journals Bioactive adrenomedullin, proenkephalin A and clinical outcomes in an acute heart failure setting

Open Heart ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. e001048 ◽  
Author(s):  
John Molvin ◽  
Amra Jujic ◽  
Silvia Navarin ◽  
Olle Melander ◽  
Giada Zoccoli ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Acute Heart Failure ◽  
Area Under The Curve ◽  
Length Of Hospital Stay ◽  
Multivariable Logistic Regression Analysis ◽  
Potential Marker ◽  
Proenkephalin A

ObjectivesIn an acute heart failure (AHF) setting, proenkephalin A 119–159 (penKid) has emerged as a promising prognostic marker for predicting worsening renal function (WRF), while bioactive adrenomedullin (bio-ADM) has been proposed as a potential marker for congestion. We examined the diagnostic value of bio-ADM in congestion and penKid in WRF and investigated the prognostic value of bio-ADM and penKid regarding mortality, rehospitalisation and length of hospital stay in two separate European AHF cohorts.MethodsBio-ADM and penKid were measured in 530 subjects hospitalised for AHF in two cohorts: Swedish HeArt and bRain failure inVESTigation trial (HARVEST-Malmö) (n=322, 30.1% female; mean age 75.1+11.1 years; 12 months follow-up) and Italian GREAT Network Rome study (n=208, 54.8% female; mean age 78.5+9.9 years; no follow-up available).ResultsPenKid was associated with WRF (area under the curve (AUC) 0.65, p<0.001). In multivariable logistic regression analysis of the pooled cohort, penKid showed an independent association with WRF (adjusted OR (aOR) 1.74, p=0.004). Bio-ADM was associated with peripheral oedema (AUC 0.71, p<0.001), which proved to be independent after adjustment (aOR 2.30, p<0.001). PenKid was predictive of in-hospital mortality (OR 2.24, p<0.001). In HARVEST-Malmö, both penKid and bio-ADM were predictive of 1-year mortality (aOR 1.34, p=0.038 and aOR 1.39, p=0.030). Furthermore, bio-ADM was associated with rehospitalisation (aOR 1.25, p=0.007) and length of hospital stay (β=0.702, p=0.005).ConclusionIn two different European AHF cohorts, bio-ADM and penKid perform as suitable biomarkers for early detection of congestion severity and WRF occurrence, respectively, and are associated with pertinent clinical outcomes.

scholarly journals Clinical Approach to Shortening Length of Hospital Stay in Elderly Patients With Acute Heart Failure Requiring Intensive Care

2020 ◽  
Vol 2 (2) ◽  
pp. 95-103
Author(s):  
Akihiro Shirakabe ◽  
Kuniya Asai ◽  
Toshiaki Otsuka ◽  
Nobuaki Kobayashi ◽  
Hirotake Okazaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intensive Care ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Acute Heart Failure ◽  
Length Of Hospital Stay ◽  
Clinical Approach
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