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

Tables

Table 1. Patient Characteristics
 
CharacteristicsOral 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 diuretic0.77
  % on furosemide88.990.2
  % on bumetanide5.73.9
  % on torsemide5.15.9

 

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 0120 (85)114 (82)0.58
  Day 1109 (93)114 (91)0.60
  Last full day66 (42)a100 (96)< 0.01
Diuretic given day 00.34
  Furosemide (%)93.596.9
  Bumetanide (%)3.30.8
  Others/combined (%)2.02.3
Diuretic given day 10.34
  Furosemide (%)94.597.7
  Bumetanide (%)3.00.8
  Others/combined (%)2.41.6
Diuretic given last full day0.07
  Furosemide (%)88.290.7
  Bumetanide (%)6.71.4
  Others/combined (%)5.07.9
% received metolazone
  Day 0 (%)13.34.3< 0.01
  Day 1 (%)16.87.80.02
  Last full day (%)7.517.7< 0.01
% received inotrope during admission36.4%30.5%0.27

 

Table 3. Characteristics on Day of Discharge
 
CharacteristicsOral 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-blocker42.8%42.6%0.97
ACEI33.0%24.1%0.09
Spironolactone13.3%19.9%0.12
Loop diuretic dose adjustment compared to home loop diuretic dose
  Increased36.6%45.3%0.12
  No change38.4%39.6%0.83
  Decreased25.0%15.1%0.03
Discharge furosemide PO dose equivalent63 (44)85 (74)< 0.01
% discharged without diuretic23.8%12.2%< 0.01
Discharge diuretic0.97
  % discharged on furosemide89.390.2
  % discharged on bumetanide6.15.7
  % discharged on torsemide4.64.1

 

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