TY - JOUR
T1 - Inpatient versus outpatient intravenous diuresis for the acute exacerbation of chronic heart failure
AU - Halatchev, Ilia G.
AU - Wu, Wen Chin
AU - Heidenreich, Paul A.
AU - Djukic, Elma
AU - Balasubramanian, Sumitra
AU - Ohlms, Kelly B.
AU - McDonald, Jay R.
N1 - Publisher Copyright:
© 2021
PY - 2021/10
Y1 - 2021/10
N2 - Background: We established an IV outpatient diuresis (IVOiD) clinic and conducted a quality improvement project to evaluate safety, effectiveness and costs associated with outpatient versus inpatient diuresis for patients presenting with acute decompensated heart failure (ADHF) to the emergency department (ED). Methods: Patients who were clinically diagnosed with ADHF in the ED, but did not have high-risk features, were either diuresed in the hospital or in the outpatient IVOiD clinic. The dose of IV diuretic was based on their home maintenance diuretic dose. The outcomes measured were the effects of diuresis (urine output, weight, hemodynamic and laboratory abnormalities), 30–90 day readmissions, 30–90 day death and costs. Results: In total, 36 patients (22 inpatients and 14 outpatients) were studied. There were no significant differences in the baseline demographics between groups. The average inpatient stay was six days and the average IVOiD clinic days were 1.2. There was no significant difference in diuresis per day of treatment (1159 vs. 944 ml, p = 0.46). There was no significant difference in adverse outcomes, 30–90 day readmissions or 30–90 day deaths. There was a significantly lower cost in the IVOiD group compared to the inpatient group ($839.4 vs. $9895.7, p=<0.001). Conclusions: Outpatient IVOiD clinic diuresis may be a viable alternative to accepted clinical practice of inpatient diuresis for ADHF. Further studies are needed to validate this in a larger cohort and in different sites.
AB - Background: We established an IV outpatient diuresis (IVOiD) clinic and conducted a quality improvement project to evaluate safety, effectiveness and costs associated with outpatient versus inpatient diuresis for patients presenting with acute decompensated heart failure (ADHF) to the emergency department (ED). Methods: Patients who were clinically diagnosed with ADHF in the ED, but did not have high-risk features, were either diuresed in the hospital or in the outpatient IVOiD clinic. The dose of IV diuretic was based on their home maintenance diuretic dose. The outcomes measured were the effects of diuresis (urine output, weight, hemodynamic and laboratory abnormalities), 30–90 day readmissions, 30–90 day death and costs. Results: In total, 36 patients (22 inpatients and 14 outpatients) were studied. There were no significant differences in the baseline demographics between groups. The average inpatient stay was six days and the average IVOiD clinic days were 1.2. There was no significant difference in diuresis per day of treatment (1159 vs. 944 ml, p = 0.46). There was no significant difference in adverse outcomes, 30–90 day readmissions or 30–90 day deaths. There was a significantly lower cost in the IVOiD group compared to the inpatient group ($839.4 vs. $9895.7, p=<0.001). Conclusions: Outpatient IVOiD clinic diuresis may be a viable alternative to accepted clinical practice of inpatient diuresis for ADHF. Further studies are needed to validate this in a larger cohort and in different sites.
KW - Acute decompensated heart failure
KW - Diuresis
KW - Emergency department
KW - Heart failure
KW - Outcomes
UR - http://www.scopus.com/inward/record.url?scp=85117083164&partnerID=8YFLogxK
U2 - 10.1016/j.ijcha.2021.100860
DO - 10.1016/j.ijcha.2021.100860
M3 - Article
C2 - 34485679
AN - SCOPUS:85117083164
SN - 2352-9067
VL - 36
JO - IJC Heart and Vasculature
JF - IJC Heart and Vasculature
M1 - 100860
ER -