Evaluating the dual impact of dose and time to administration of IV loop diuretics in acute heart failure patients Kimberly Keller, Travis Fleming, Sampaguita Wright, Laura Bullock Univeristy of Tennessee Medical Center (Internal Medicine) - Knoxville, TN
Background/Purpose: Current ACCF/AHA guidelines recommend that patients admitted with acute heart failure (AHF) and fluid overload promptly receive IV loop diuretics. For patients who are already receiving maintenance oral loop diuretic therapy prior to admission, the recommended initial IV dose should equal or exceed their daily maintenance dose. The purpose of this study is to evaluate the potential dual impact of dose and time to administration of IV loop diuretic therapy in AHF patients.
Methodology: The study design is a retrospective chart review of patients admitted through the emergency department with a primary diagnosis of AHF. Patients who received IV loop diuretics and had a history of chronic HF on maintenance oral loop diuretics prior to admission will be included. These patients will then be sorted into the following four groups: high dose (IV loop diuretic dose at least double the maintenance oral diuretic dose) or low dose (IV loop diuretic dose less than double the maintenance oral diuretic dose) and early administration (door-to-loop time less than 60 minutes from admission) or delayed administration (door-to-loop time greater than or equal to 60 minutes from admission). The following pertinent data will be collected: demographics, weight, intake and output, concurrent medications, ejection fraction, loop route of administration, and vital signs. The primary endpoint will be the time in hours to conversion from IV loop diuretic to oral loop diuretic therapy. Secondary endpoints will include length of stay, in-hospital mortality, 30-day readmissions, patients requiring supplemental IV loop diuretic doses post-oral conversion, worsening renal function, and rates of severe hypokalemia and hypomagnesemia.
Presentation Objective: To determine the effect of both the dosing and timing of IV loop diuretic therapy in AHF patients.
Self-Assessment: What is the potential benefit of early administration of guideline recommended doses of loop diuretics in AHF patients?
