Preventable delays to intravenous furosemide administration in the emergency department prolong hospitalization for patients with acute heart failure

Ward, Michael J.; Collins, Sean P.; Liu, Dandan; Froehle, Craig M.

doi:10.1016/j.ijcard.2018.06.087

Cited by 6 publications

(35 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The median time‐to‐diuretics in previous studies ranged from 90 min in Japan up to 166 min in the United States, with fewer signs of congestion in patients from the United States than Japan 7,9 ( Table 2 ). More signs of congestion predicted shorter time‐to‐diuretics in the present and previous studies, 7,9 suggesting that symptom severity might compel physicians to start diuretics earlier. In REPORT‐HF, there were notable geographic differences in time‐to‐diuretics, independent of signs and symptoms, suggesting that the threshold to time‐to‐diuretics was determined by local healthcare practices more than by patient characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…Because a previous publication found a modifying effect of baseline patient mortality risk, 9 we tested whether the ADHERE risk score 21 or MAGGIC risk score 22 modified the association between time‐to‐diuretics and mortality. We combined patients with intermediate‐2, intermediate‐1, and high ADHERE scores because of the small sample size ( n = 1657, n = 303 and n = 467, respectively).…”

Section: Methodsmentioning

confidence: 99%

“…Two studies suggested that a delay in initiating intravenous (IV) diuretics was associated with higher in‐hospital and post‐discharge mortality 7,9 . Conversely, a single study from South Korea showed no significant association between time‐to‐diuretics and mortality 8 .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Association of time‐to‐intravenous furosemide with mortality in acute heart failure: data from REPORT‐HF

Ouwerkerk

Tromp

Cleland

et al. 2022

European J of Heart Fail

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Association of time‐to‐intravenous furosemide with mortality in acute heart failure: data from REPORT‐HF

Ouwerkerk

Tromp

Cleland

et al. 2022

European J of Heart Fail

Self Cite

View full text Add to dashboard Cite

show abstract

“…Indeed, timing of intravenous furosemide administration in the ED has been shown to be crucial, in view of the fact that delaying furosemide administration, until after serum creatinine laboratory results become available, has been associated with a 41% lower probability of successful discharge home. It is noteworthy that the association between timing of furosemide administration and likelihood of successful discharge was most potent in low-acuity AHF patients [ 59 ].…”

Section: Observation Unit For Ahf Managementmentioning

confidence: 99%

Emergency department risk assessment and disposition of acute heart failure patients: existing evidence and ongoing challenges

et al. 2022

View full text Add to dashboard Cite

Heart failure (HF) is a global public health burden, characterized by frequent emergency department (ED) visits and hospitalizations. Identifying successful strategies to avoid admissions is crucial for the management of acutely decompensated HF, let alone resource utilization. The primary challenge for ED management of patients with acute heart failure (AHF) lies in the identification of those who can be safely discharged home instead of being admitted. This is an elaborate decision, based on limited objective evidence. Thus far, current biomarkers and risk stratification tools have had little impact on ED disposition decision-making. A reliable definition of a low-risk patient profile is warranted in order to accurately identify patients who could be appropriate for early discharge. A brief period of observation can facilitate risk stratification and allow for close monitoring, aggressive treatment, continuous assessment of response to initial therapy and patient education. Lung ultrasound may represent a valid bedside tool to monitor cardiogenic pulmonary oedema and determine the extent of achieved cardiac unloading after treatment in the observation unit setting. Safe discharge mandates multidisciplinary collaboration and thoughtful assessment of socioeconomic and behavioural factors, along with a clear post-discharge plan put forward and a close follow-up in an outpatient setting. Ongoing research to improve ED risk stratification and disposition of AHF patients may mitigate the tremendous public health challenge imposed by the HF epidemic.

show abstract

“…Prior work has demonstrated that common bedside findings (including elevated jugular venous pressure, rales, and peripheral oedema) have variable sensitivity and specificity to identify the presence of volume overload and elevated filling pressures 11 . Indeed, in an analysis on the association between time‐to‐diuretics and clinical outcomes in patients presenting to a single quaternary emergency department, 32.8% of patients (907/2767) admitted to the hospital with a presumed diagnosis of AHF were subsequently identified to have a different primary diagnosis by the time of discharge 6 . Laboratory, radiographic, and invasive haemodynamic findings greatly enhance diagnostic accuracy, though likely reduce speed to diuretic delivery.…”

mentioning

confidence: 99%

Time to diuretics in acute heart failure: the tortoise or the hare?

Lerman

Felker

2022

European J of Heart Fail

View full text Add to dashboard Cite

This article refers to 'Association of time-to-intravenous furosemide with mortality in acute heart failure: data from REPORT-HF' by W. Ouwerkerk et al., published in this issue on pages 43-51.There are acute cardiovascular conditions in which the speed of treatment is directly correlated with clinical outcomes -most notably, in ST-elevation myocardial infarction ('door-to-balloon time') and in cardiac arrest (time to defibrillation). The success of efforts to increase the speed of treatment in such diseases has prompted clinicians to explore whether more rapid care delivery might lead to improved outcomes for other similar diagnoses. Acute heart failure (AHF) is one of the most common causes of hospitalization worldwide and is associated with significant morbidity and mortality. 1 Decompensation is most often characterized by signs and symptoms of congestion, and the backbone of treatment is typically the escalation of diuretics. Prior work exploring the relationship between the speed of diuretic delivery (i.e. 'door-to-diuretic time') and clinical outcomes in AHF has revealed largely neutral results. [2][3][4][5][6] In this issue of the Journal, Ouwerkerk and colleagues provide a valuable contribution to this body of work. 7 Utilizing the international, multicentre, REPORT-HF registry, 8 the authors assessed the association of time-to-diuretics with in-hospital and 30-day conditional post-discharge mortality in 15 078 patients presenting with AHF between 2014 and 2017. In their analysis, time-to-diuretic was not associated with in-hospital mortality. However, longer time-to-diuretic was associated with higher 30-day conditional post-discharge mortality. This association was increased amongst patients with higher baseline risk based on the ADHERE risk score, 9 and was not modified by left ventricular ejection fraction or geographic region.This study has several notable strengths. Prior investigations of time-to-diuretic and outcomes in AHF have generally analysed data from single centres or individual countries. [2][3][4][5][6] This study utilized prospectively collected data from subjects in 44 countries, resulting in the most diverse and representative global cohort to date in which this relationship has been evaluated.

show abstract

Preventable delays to intravenous furosemide administration in the emergency department prolong hospitalization for patients with acute heart failure

Cited by 6 publications

References 30 publications

Association of time‐to‐intravenous furosemide with mortality in acute heart failure: data from REPORT‐HF

Association of time‐to‐intravenous furosemide with mortality in acute heart failure: data from REPORT‐HF

Emergency department risk assessment and disposition of acute heart failure patients: existing evidence and ongoing challenges

Time to diuretics in acute heart failure: the tortoise or the hare?

Contact Info

Product

Resources

About