title: The diuresis clinic: a new paradigm for the treatment of mild decompensated heart failure.
abstract: BACKGROUND
  Heart failure results in approximately 1 million hospital admissions annually in the United States and is the leading cause of 30-day readmissions.
  
  
  METHODS
  This study explores the impact of a diuresis clinic on heart failure outcomes and cost. Data were collected prospectively on all consecutive patients who received intravenous diuretics and multidisciplinary care in the clinic from its establishment from October 2011 to December 2012, as well as a comparison cohort of patients with heart failure who were admitted to the hospital for <48 hours. The percentage of hospitalized days was calculated for both cohorts 180 days before and 180 days after each patient's index visit.
  
  
  RESULTS
  In the diuresis clinic group, 106 patients (mean age, 68.2 ± 13 years; 48% were women) were treated over 328 visits (1-22 visits per person), with a mean intravenous furosemide dose of 100 mg, average urine output of 1460 ± 730 mL, and weight loss of 2.3 ± 1.8 kg. Days hospitalized decreased from 38.3 to 31.2 per 1000 patient-days after the index diuresis clinic visit (P < .01). In the comparison group, 143 patients (mean age, 69 ± 16 years; 54% were women) were admitted for <48 hours. Days hospitalized increased from 14.4 to 21.0 per 1000 patient-days after index admission (P < .01). On multivariate analysis, the diuresis clinic was associated with 3 fewer days in the hospital per 180 days per patient, with an estimated annual savings of $12,113 per patient.
  
  
  CONCLUSIONS
  Compared with a brief hospital stay, treatment of mild decompensated heart failure in a diuresis clinic resulted in a substantial and cost-effective decline in the rate of subsequent hospitalization.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Sunal
authors.initials: S
authors.lastname: Makadia
authors.affiliation: Johns Hopkins Bayview Medical Center, Baltimore, Md.
authors.forename: Tanya
authors.initials: T
authors.lastname: Simmons
authors.affiliation: Johns Hopkins Bayview Medical Center, Baltimore, Md.
authors.forename: Sharon
authors.initials: S
authors.lastname: Augustine
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Lara
authors.initials: L
authors.lastname: Kovell
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Che
authors.initials: C
authors.lastname: Harris
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Abednego
authors.initials: A
authors.lastname: Chibungu
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Md. Electronic address: kapil.parakh@gmail.com.
authors.forename: Kapil
authors.initials: K
authors.lastname: Parakh
mesh_terms: D000368:Aged; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004232:Diuretics / Q000008:administration & dosage*; D005260:Female; D005665:Furosemide / Q000008:administration & dosage*; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010044:Outpatient Clinics, Hospital / Q000191:economics; D058996:Quality Improvement; D013812:Therapeutics
chemical_list: D004232:Diuretics; D005665:Furosemide
keywords: Care delivery; Health innovation; Heart failure; Quality improvement