Higher diuretic dose within the first 72 hours is predictive of longer length of stay in patients with acute heart failure

Abstract

Objective:High-dose diuretic strategies during the first 72 h of hospitalization have been shown to improve symptom resolution in patients with acute heart failure with decreased ejection fraction; however, they have not been shown to decrease length of stay (LOS). This study aimed to examine a possible relationship between higher diuretic dosing in the first 72 h of hospitalization and longer LOS in such patients.Methods:In this retrospective study, we included 333 consecutive patients hospitalized for acute heart failure with decreased or preserved ejection fraction between July 2014 and June 2015 in an urban academic medical center. Multiple regression models with stepwise selection were used for data analysis. We also performed mediation analysis to assess the relationships between diuretic dose, worsening renal function (WRF) during the hospitalization, and LOS.Results:In the multiple regression analysis, higher diuretic dosing in the first 72 h independently predicted longer LOS [β=0.42, 95% CI (0.27, 0.56), p<0.001] after adjustments for baseline characteristics, disease severity, and comorbidities. In the mediation analysis, higher diuretic dosing remained a significant predictor for longer LOS even after controlling for the mediator WRF [β=0.39, 95% CI (0.26, 0.53), p<0.001]. WRF had a weak mediation effect on the relationship between higher diuretic dosing and longer LOS [indirect effect of higher diuretic dosing on longer LOS: 0.07, 95% CI (0.02, 0.14)].Conclusion:Higher diuretic dosing in the first 72 h of hospitalization was an independent predictor for longer LOS.

Predictive factors for longer length of hospital stay in patients with heart failure

“…I have read the article by Kato et al (1) entitled “Higher diuretic dosing within the first 72 h is predictive of longer length of stay in patients with acute heart failure” which was published in Anatol J Cardiol 2018; 20: 110-6, with great interest. In their study, authors reported that higher diuretic dosing in the first 72 h of hospitalization was an independent predictor of longer length of hospital stay in patients with acute heart failure.…”

“…In addition, they concluded that there could be important predictors of the length of hospital stay that were not included in their study. Beside this, they reported that laboratory data of patients, including serum sodium level and cardiac troponin values, were recorded on admission and during the first 72 h of hospitalization (1). I would like to emphasize some important points about this well-written study.…”

Length of hospital stay, diuretic dosing, and regression strategies

“…In previous issues of the journal, we read with great interest the article by Kato et al (1) entitled “Higher diuretic dosing within the first 72 h is predictive of longer length of stay in patients with acute heart failure” published in Anatol J Cardiol 2018; 20: 110-6. The study included 333 patients with acute heart failure, and the authors demonstrated that higher diuretic dosing in the first 72 h of hospitalization was an independent predictor for a longer length of stay.…”