title: Discharge Diuretic Dose and 30-Day Readmission Rate in Acute Decompensated Heart Failure.
abstract: Loop diuretics play a crucial role in symptom management in patients with fluid overload. There is a paucity of data regarding optimal diuretic dose at hospital discharge for acute decompensated heart failure (ADHF) patients requiring loop diuretics.
  
  
  
  To compare all-cause 30-day readmission in ADHF patients on chronic loop diuretics who had an increase in loop diuretic dose at discharge (relative to their preadmission dose) with patients without a change or a decrease in loop diuretic dose at discharge.
  
  
  
  This was a multicenter, retrospective cohort study. Institutional review board approval was obtained. Patients admitted with a primary discharge diagnosis of heart failure, evidence of fluid overload, and reduced ejection fraction were included. Patients were divided into 2 groups based on total daily loop diuretic dose at discharge: those discharged on an increased dose and those discharged on a dose less than or equal to their preadmission dose.
  
  
  
  A total of 131 patient admissions met inclusion criteria; 50 had an increase in loop diuretic dose at discharge, and 81 were discharged with no change or a decrease in diuretic dose. Patients in the increased dose group had an all-cause 30-day readmission rate of 20% compared with 38% of patients with no change or a decrease in diuretic dose (adjusted odds ratio = 0.320; 95% CI = 0.117-0.873).
  
  
  
  In patients admitted for ADHF with reduced ejection fraction and evidence of fluid overload, an increase in loop diuretic dose at discharge was associated with a reduced rate of 30-day hospital readmission.
authors.affiliation: State University of New York at Buffalo, NY, USA Buffalo General Medical Center, Buffalo, NY, USA aew7@buffalo.edu.
authors.forename: Ashley E
authors.initials: AE
authors.lastname: Woodruff
authors.affiliation: Lebanon Veterans Affairs Medical Center, Lebanon, PA, USA.
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Kelley
authors.affiliation: State University of New York at Buffalo, NY, USA Buffalo General Medical Center, Buffalo, NY, USA.
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Hempel
authors.affiliation: Buffalo General Medical Center, Buffalo, NY, USA D'Youville College, Buffalo, NY, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Loeffler
authors.affiliation: Buffalo General Medical Center, Buffalo, NY, USA D'Youville College, Buffalo, NY, USA.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Echtenkamp
authors.affiliation: D'Youville College, Buffalo, NY, USA.
authors.forename: Amany K
authors.initials: AK
authors.lastname: Hassan
mesh_terms: D000208:Acute Disease; D000368:Aged; D004305:Dose-Response Relationship, Drug; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D049994:Sodium Potassium Chloride Symporter Inhibitors
keywords: cardiology; cardiovascular drugs; clinical decision making; clinical research; congestive heart failure; diuretics