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Prognostic role of diuretic failure in determining mortality for patients hospitalized with acute decompensated heart failure

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Abstract

Background

Worsening heart failure (WHF) is defined as persistent or worsening symptoms of heart failure that require an escalation in intravenous therapy or initiation of mechanical and ventilatory support during hospitalization. We assessed a simplified version of WHF called diuretic failure (DF), defined as an escalation of loop diuretic dosing after 48 h, and assessed its effects on mortality and rehospitalizations at 60-days.

Methods

We conducted a multicenter retrospective study between December 1, 2017 and January 1, 2020. We identified 1389 patients of which 6.4% experienced DF.

Results

There was a significant relationship between DF and cumulative rates of 60-day mortality and 60-day rehospitalizations (p = 0.0002 and p = 0.0214). After multivariate adjustment, DF was associated with longer hospital stay (p < 0.0001), increased rate of 60-day mortality (p = 0.026), 60-day rehospitalizations (p = 0.036), and a composite outcome of 60-day mortality and 60-day cardiac rehospitalizations (p = 0.018).

Conclusions

DF has a strong relationship with adverse heart failure outcomes suggesting it is a simple yet robust prognostic indicator which can be used in real time to identify high-risk patients during hospitalization and beyond.

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Funding

This research received no grant or financial support from any funding agency.

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Authors and Affiliations

  1. Department of Medicine, WellSpan York Hospital, York, PA, USA

    Salmaan Mumtaz, Junaid Mir & Aisha Rehman

  2. British Columbia Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada

    Mehul Sharma & Maggie P. Fu

  3. Department of Family and Community Medicine, Sunnybrook Health and Sciences Centre, University of Toronto, Toronto, ON, Canada

    Abhinav Sharma

  4. Department of Cardiology, WellSpan York Hospital, York, PA, USA

    Michael N. Vranian

Authors
  1. Salmaan Mumtaz
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  2. Mehul Sharma
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  3. Maggie P. Fu
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  4. Abhinav Sharma
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  5. Junaid Mir
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  6. Aisha Rehman
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  7. Michael N. Vranian
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Contributions

Conceptualization: SM, MPF, M S, AS, JM, AR, MNV; Methodology: SM, MPF, MS, AS; Formal analysis and investigation: MPF, MS, AS; Writing-original draft preparation: SM; Writing-review and editing: SM, MPF, MS, ASh, JM, AR, MNV; Resources: MNV; Supervision: MNV.

Corresponding author

Correspondence to Salmaan Mumtaz.

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Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

This research study was conducted retrospectively from data obtained for clinical purposes. We consulted extensively with the IRB of WellSpan York Hospital who determined that our study did not need ethical approval. An IRB official waiver of ethical approval was granted from the IRB of WellSpan York Hospital.

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Mumtaz, S., Sharma, M., Fu, M.P. et al. Prognostic role of diuretic failure in determining mortality for patients hospitalized with acute decompensated heart failure. Heart Vessels 37, 1373–1379 (2022). https://doi.org/10.1007/s00380-022-02042-x

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  • DOI: https://doi.org/10.1007/s00380-022-02042-x

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