title: Intravenous fluids in acute decompensated heart failure.
abstract: OBJECTIVE
  This study sought to determine the use of intravenous fluids in the early care of patients with acute decompensated heart failure (HF) who are treated with loop diuretics.
  
  
  BACKGROUND
  Intravenous fluids are routinely provided to many hospitalized patients.
  
  
  METHODS
  We conducted a retrospective cohort study of patients admitted with HF to 346 hospitals from 2009 to 2010. We assessed the use of intravenous fluids during the first 2 days of hospitalization. We determined the frequency of adverse in-hospital outcomes. We assessed variation in the use of intravenous fluids across hospitals and patient groups.
  
  
  RESULTS
  Among 131,430 hospitalizations for HF, 13,806 (11%) were in patients treated with intravenous fluids during the first 2 days. The median volume of administered fluid was 1,000 ml (interquartile range: 1,000 to 2,000 ml), and the most commonly used fluids were normal saline (80%) and half-normal saline (12%). Demographic characteristics and comorbidities were similar in hospitalizations in which patients did and did not receive fluids. Patients who were treated with intravenous fluids had higher rates of subsequent critical care admission (5.7% vs. 3.8%; p < 0.0001), intubation (1.4% vs. 1.0%; p = 0.0012), renal replacement therapy (0.6% vs. 0.3%; p < 0.0001), and hospital death (3.3% vs. 1.8%; p < 0.0001) compared with those who received only diuretics. The proportion of hospitalizations that used fluid treatment varied widely across hospitals (range: 0% to 71%; median: 12.5%).
  
  
  CONCLUSIONS
  Many patients who are hospitalized with HF and receive diuretics also receive intravenous fluids during their early inpatient care, and the proportion varies among hospitals. Such practice is associated with worse outcomes and warrants further investigation.
authors: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors: Behnood
authors: B
authors: Bikdeli
authors: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
authors: Kelly M
authors: KM
authors: Strait
authors: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Division of Cardiology, Columbia University Medical Center, New York, New York.
authors: Kumar
authors: K
authors: Dharmarajan
authors: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
authors: Shu-Xia
authors: SX
authors: Li
authors: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Purav
authors: P
authors: Mody
authors: Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors: Chohreh
authors: C
authors: Partovian
authors: Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors: Steven G
authors: SG
authors: Coca
authors: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors: Nancy
authors: N
authors: Kim
authors: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors: Leora I
authors: LI
authors: Horwitz
authors: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors: Jeffrey M
authors: JM
authors: Testani
authors: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut. Electronic address: harlan.krumholz@yale.edu.
authors: Harlan M
authors: HM
authors: Krumholz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005440:Fluid Therapy; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D007552:Isotonic Solutions / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D000077331:Ringer's Solution; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D007552:Isotonic Solutions; D012462:Saline Solution, Hypertonic; D049994:Sodium Potassium Chloride Symporter Inhibitors; D000077331:Ringer's Solution
keywords: diuretics; heart failure; intravenous fluids