Impact of transitioning patients to oral diuretics 24 hours before discharge from heart failure hospitalization on 30 day outcomes.

BACKGROUND

Patients hospitalized for heart failure (HF) are at high risk for post-discharge events. Although transition from intravenous to oral diuretics for ≥24 h is commonly practiced to reduce post-discharge risk, evidence supporting this strategy is limited. We investigated the impact of this practice on 30 day post-discharge outcomes following HF hospitalization at our institution.

METHODS

Retrospective chart review of patients hospitalized with a primary HF diagnosis, discharged on oral diuretic, and followed at our institution. Admission, in-hospital, and pre-discharge characteristics of patients discharged with ≥24-h observation were compared to those of patients observed for <24-h on oral diuretics. Differences between groups in composite 30 day all-cause mortality and rehospitalization, each component, and HF rehospitalization were assessed.

RESULTS

Of 285 patients meeting entry criteria, 178 received oral diuretics ≥24 h prior to discharge and 107 were discharged <24 h after transitioning to oral diuretics. Baseline characteristics were similar between groups. Patients with ≥24 h observation on oral diuretics had longer in-hospital stays and greater weight and net volume loss than those observed <24 h. Patients receiving oral diuretics for <24 h were more likely to have had neurohormonal drugs and diuretic dose changed within 24-h of discharge. Oral diuretic treatment for ≥24 h failed to reduce any study endpoint.

CONCLUSIONS

Transitioning patients to oral diuretics for ≥24 h prior to discharge following HF hospitalization failed to improve 30-day outcomes. These results question this strategy for all patients hospitalized for worsening HF.