Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 12, Number 4, August 2021, pages 244-250

Trial of Oral Diuretics Prior to Discharge Is Not Associated With Improved Outcomes in Decompensated Heart Failure

**Table 1.** Patient Characteristics
Characteristics	Oral diuretic on last full day (group 1, n = 173)	IV diuretics on last full day (group 2, n = 141)	P value
Data were presented as mean (standard deviation) or percentage (where indicated). IV: intravenous; PO: per os.
Age (years)	61.9 (15.7)	63.0 (16.8)	0.57
Sex (%women)	34.7%	37.6%	0.60
Diabetes mellitus (%)	23.1%	24.8%	0.73
Chronic obstructive pulmonary disease (%)	8.7%	7.1%	0.61
Chronic kidney disease (%)	17.3%	17.0%	0.94
Chronic ischemic heart disease (%)	35.8%	34.8%	0.84
Atrial fibrillation (%)	29.5%	22.7%	0.17
Admit sodium (mEq/L)	137.3 (5.4)	137.6 (5.06)	0.65
Admit potassium (mmol/L)	4.3 (0.7)	4.3 (0.63)	0.83
Admit creatinine (mg/dL)	1.3 (0.71)	1.5 (0.93)	0.24
Admit pro-B-type natriuretic peptide (pro-BNP) (pg/mL)	10,339.4 (12,060.0)	8,728.9 (8,626.4)	0.20
Admit blood pressure (mm Hg)	127 (24)/79 (16)	128 (23)/79 (17)	0.69/0.97
Admit left ventricle ejection fraction (%)	23 (14)	26 (15)	0.09
Admit furosemide PO dose equivalent (mg)	71 (49)	76 (61)	0.54
Pre-admission diuretic			0.77
% on furosemide	88.9	90.2
% on bumetanide	5.7	3.9
% on torsemide	5.1	5.9

Table 1. Patient Characteristics

Characteristics

Oral diuretic on last full day (group 1, n = 173)

IV diuretics on last full day (group 2, n = 141)

P value

Data were presented as mean (standard deviation) or percentage (where indicated). IV: intravenous; PO: per os.

Age (years)

61.9 (15.7)

63.0 (16.8)

0.57

Sex (%women)

34.7%

37.6%

0.60

Diabetes mellitus (%)

23.1%

24.8%

0.73

Chronic obstructive pulmonary disease (%)

8.7%

7.1%

0.61

Chronic kidney disease (%)

17.3%

17.0%

0.94

Chronic ischemic heart disease (%)

35.8%

34.8%

0.84

Atrial fibrillation (%)

29.5%

22.7%

0.17

Admit sodium (mEq/L)

137.3 (5.4)

137.6 (5.06)

0.65

Admit potassium (mmol/L)

4.3 (0.7)

4.3 (0.63)

0.83

Admit creatinine (mg/dL)

1.3 (0.71)

1.5 (0.93)

0.24

Admit pro-B-type natriuretic peptide (pro-BNP) (pg/mL)

10,339.4 (12,060.0)

8,728.9 (8,626.4)

0.20

Admit blood pressure (mm Hg)

127 (24)/79 (16)

128 (23)/79 (17)

0.69/0.97

Admit left ventricle ejection fraction (%)

23 (14)

26 (15)

0.09

Admit furosemide PO dose equivalent (mg)

71 (49)

76 (61)

0.54

Pre-admission diuretic

0.77

% on furosemide

88.9

90.2

% on bumetanide

5.7

3.9

% on torsemide

5.1

5.9

**Table 2.** In-Hospital Medication Administration
	Oral diuretics on last full day (n = 173)	IV diuretics on last full day (n = 141)	P value
Data were presented as mean (standard deviation). ^aIndicates oral diuretic dose. IV: intravenous.
Total mg IV furosemide equivalent dose
Day 0	120 (85)	114 (82)	0.58
Day 1	109 (93)	114 (91)	0.60
Last full day	66 (42)^a	100 (96)	< 0.01
Diuretic given day 0			0.34
Furosemide (%)	93.5	96.9
Bumetanide (%)	3.3	0.8
Others/combined (%)	2.0	2.3
Diuretic given day 1			0.34
Furosemide (%)	94.5	97.7
Bumetanide (%)	3.0	0.8
Others/combined (%)	2.4	1.6
Diuretic given last full day			0.07
Furosemide (%)	88.2	90.7
Bumetanide (%)	6.7	1.4
Others/combined (%)	5.0	7.9
% received metolazone
Day 0 (%)	13.3	4.3	< 0.01
Day 1 (%)	16.8	7.8	0.02
Last full day (%)	7.5	17.7	< 0.01
% received inotrope during admission	36.4%	30.5%	0.27

Table 2. In-Hospital Medication Administration

Oral diuretics on last full day (n = 173)

IV diuretics on last full day (n = 141)

P value

Data were presented as mean (standard deviation). ^aIndicates oral diuretic dose. IV: intravenous.

Total mg IV furosemide equivalent dose

Day 0

120 (85)

114 (82)

0.58

Day 1

109 (93)

114 (91)

0.60

Last full day

66 (42)^a

100 (96)

< 0.01

Diuretic given day 0

0.34

Furosemide (%)

93.5

96.9

Bumetanide (%)

3.3

0.8

Others/combined (%)

2.0

2.3

Diuretic given day 1

0.34

Furosemide (%)

94.5

97.7

Bumetanide (%)

3.0

0.8

Others/combined (%)

2.4

1.6

Diuretic given last full day

0.07

Furosemide (%)

88.2

90.7

Bumetanide (%)

6.7

1.4

Others/combined (%)

5.0

7.9

% received metolazone

Day 0 (%)

13.3

4.3

< 0.01

Day 1 (%)

16.8

7.8

0.02

Last full day (%)

7.5

17.7

< 0.01

% received inotrope during admission

36.4%

30.5%

0.27

**Table 3.** Characteristics on Day of Discharge
Characteristics	Oral diuretics on last full day (n = 173)	IV diuretics on last full day (n = 141)	P value
Discharge sodium (mEq/L)	135.9 (3.9)	136.7 (3.8)	0.08
Discharge potassium (mmol/L)	4.2 (0.4)	4.1 (0.4)	0.06
Discharge creatinine (mg/dL)	1.4 (0.7)	1.5 (0.8)	0.22
Discharge blood pressure (mm Hg)	111 (19)/65 (12)	112 (16)/66 (10)	0.60/0.68
Average weight loss (kg)	2.1 (4.2)	3.7 (6.7)	0.01

Table 3. Characteristics on Day of Discharge

Characteristics

Oral diuretics on last full day (n = 173)

IV diuretics on last full day (n = 141)

P value

Discharge sodium (mEq/L)

135.9 (3.9)

136.7 (3.8)

0.08

Discharge potassium (mmol/L)

4.2 (0.4)

4.1 (0.4)

0.06

Discharge creatinine (mg/dL)

1.4 (0.7)

1.5 (0.8)

0.22

Discharge blood pressure (mm Hg)

111 (19)/65 (12)

112 (16)/66 (10)

0.60/0.68

Average weight loss (kg)

2.1 (4.2)

3.7 (6.7)

0.01

**Table 4.** Discharge Medications
Medication class at goal dose or up titrated from admission to discharge (% of patients)	Oral diuretics on last full day (n = 173)	IV diuretics on last full day (n = 141)	P value
ACEI: angiotensin-converting enzyme inhibitor; PO: per os.
Beta-blocker	42.8%	42.6%	0.97
ACEI	33.0%	24.1%	0.09
Spironolactone	13.3%	19.9%	0.12
Loop diuretic dose adjustment compared to home loop diuretic dose
Increased	36.6%	45.3%	0.12
No change	38.4%	39.6%	0.83
Decreased	25.0%	15.1%	0.03
Discharge furosemide PO dose equivalent	63 (44)	85 (74)	< 0.01
% discharged without diuretic	23.8%	12.2%	< 0.01
Discharge diuretic			0.97
% discharged on furosemide	89.3	90.2
% discharged on bumetanide	6.1	5.7
% discharged on torsemide	4.6	4.1

Table 4. Discharge Medications

Medication class at goal dose or up titrated from admission to discharge (% of patients)

Oral diuretics on last full day (n = 173)

IV diuretics on last full day (n = 141)

P value

ACEI: angiotensin-converting enzyme inhibitor; PO: per os.

Beta-blocker

42.8%

42.6%

0.97

ACEI

33.0%

24.1%

0.09

Spironolactone

13.3%

19.9%

0.12

Loop diuretic dose adjustment compared to home loop diuretic dose

Increased

36.6%

45.3%

0.12

No change

38.4%

39.6%

0.83

Decreased

25.0%

15.1%

0.03

Discharge furosemide PO dose equivalent

63 (44)

85 (74)

< 0.01

% discharged without diuretic

23.8%

12.2%

< 0.01

Discharge diuretic

0.97

% discharged on furosemide

89.3

90.2

% discharged on bumetanide

6.1

5.7

% discharged on torsemide

4.6

4.1

**Table 5.** Outcome Analysis
	Oral diuretic on last full day (n = 173)	IV diuretics on last full day (n = 141)	P value
IV: intravenous.
Length of stay (days)	6.8 (2.7)	5.2 (2.5)	< 0.01
30-day any readmission (%)	18.5%	19.9%	0.76
30-day hospitalization-free survival (%)	80.4%	78.0%	0.61

Table 5. Outcome Analysis

Oral diuretic on last full day (n = 173)

IV diuretics on last full day (n = 141)

P value

IV: intravenous.

Length of stay (days)

6.8 (2.7)

5.2 (2.5)

< 0.01

30-day any readmission (%)

18.5%

19.9%

0.76

30-day hospitalization-free survival (%)

80.4%

78.0%

0.61