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Decongestion therapy: does it differ from discharge to usual life conditions and among heart failure patients?

Session Poster Session 2

Speaker Francisco Adragao

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure – Treatment
  • Session type : Poster Session

Authors : F Adragao (Portimão,PT), I Nabais (Cascais,PT), I Costa (Lisbon,PT), I Egidio (Lisbon,PT), P Moniz (Lisbon,PT), L Campos (Lisbon,PT), I Araujo (Lisbon,PT), C Fonseca (Lisbon,PT)

Authors:
F Adragao1 , I Nabais2 , I Costa3 , I Egidio4 , P Moniz5 , L Campos4 , I Araujo5 , C Fonseca5 , 1Centro Hospitalar Universitário do Algarve - Hospital de Portimão, Medicina Interna - Portimão - Portugal , 2Hospital de Cascais, Medicina Interna - Cascais - Portugal , 3Hospital de São José, Medicina Interna - Lisbon - Portugal , 4Hospital de Sao Francisco Xavier, Medicina Interna - Lisbon - Portugal , 5Hospital de Sao Francisco Xavier, Unidade de Insuficiência Cardiaca - Lisbon - Portugal ,

Citation:

Introduction: Most decompensations of heart failure (HF) are due to congestion. At discharge from hospitalization patients are supposed to be in their dry weight, as congestive signs at this time are a predictor of rehospitalizations and mortality. Although most times euvolemic state is obtained during hospitalization, ambulatory habits and lifestyle diverge from hospital conditions, and medication might need to be adjusted.

Objective: To evaluate the adequacy of the prescribed diuretic dose at discharge on ambulatory conditions at reassessment after 2 weeks (average), and if there are differences on the diuretic dose among ejection fraction groups.

Methods: Retrospective study of consecutive hospitalizations due to decompensated HF in an Acute Heart Failure Unit (AHFU) over one year, between November 2017 and October 2018, examining hospital databases. Patients who were reassessed in a period of 30 days in Day Hospital (DH) were selected, and diuretic therapy changes were assessed.

Results: Of 162 patients discharged directly from the AHFU, 142 (87.7%) were referred to DH revaluation; of these, 29 didn’t attend to the booked appointment, with a final population of 113 patients. The mean time to reassessment was 12 days, with 37 (32.7%) patients needing to increase diuretic dose at this time due to congestion (average of 3.6 kg weight increase) – 81.0% needed to increase loop diuretic dose, 45.9% thiazidic-like and 8.1% mineralocorticoid receptor antagonists (MRA). 70.2% of them were with sequential nephron blockage. 51.4% patients needed endovenous diuretic administration in the first evaluation and 3 were rehospitalized before 30 days after discharge due to decompensated HF. Out of 76 patients that didn’t need diuretic adjustment in their visit, only 2 were readmitted in 30 days due to decompensated HF. 31.0% of non-reduced ejection fraction (non-HFrEF) needed diuretic adjustment and 34.5% of reduced ejection fraction (HFrEF)needed it as well.

Conclusion: Nearly a third of patients revaluated at DH needed diuretic adjustment at the first visit, with no difference between HFrEF and non-HFrEF. This supports the importance of early revaluation after discharge for therapy readjustment, preventing future readmissions. In our experience, revaluation at 12 days allowed not only adjustment of oral diuretic dose but also administration of IV diuretic, preventing 84.2% rehospitalizations. Diuretic doses at discharge might be appropriate for in-hospital setting, but commonly not enough at ambulatory environment. Future studies should be directed to the increase of diuretic dosage at discharge in order to prevent early readmissions and mortality.

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