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Higher diuretic dose within the first 72 hours is predictive of longer length of stay in patients with acute heart failure [Anatol J Cardiol]
Anatol J Cardiol. Ahead of Print: AJC-81568 | DOI: 10.14744/AnatolJCardiol.2018.81568  

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

Hirotaka Kato, Perry Fisher, Dahlia Rizk
Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai

Objective: High-dose diuretic strategies during the first 72 hours of hospitalization have been shown to improve symptom resolution in patients with acute heart failure with reduced ejection fraction, however have not been shown to shorten length of stay (LOS). This study aimed to examine a possible relationship between higher diuretic dosing in the first 72 hours of hospitalization and longer LOS.
Methods: This study retrospectively analyzed 333 consecutive patients who were hospitalized for acute heart failure with reduced or preserved ejection fraction between July 2014 and June 2015 in an urban academic medical center. Multiple regression models with step-wise selection were used for data analysis. We also performed mediation analysis to assess the relationships between diuretic dose, worsening renal function during the hospitalization (WRF), and LOS.
Results: In the regression analysis, higher diuretic dosing in the first 72 hours independently predicted longer LOS (β= 0.42, 95% CI [0.27, 0.56], p < 0.001) after adjusting for baseline characteristics, severity of illness, and comorbid conditions. In the mediation analysis, higher diuretic dosing remained a significant predictor of 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 hours of hospitalization was an independent predictor of longer LOS.

Keywords: heart failure, diuretics, worsening renal function, length of stay




Corresponding Author: Hirotaka Kato, United States


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