The effect of early diuretic therapy in the Emergency Department on clinical outcomes in patients hospitalized with acute heart failure
Keywords:
diuretics, emergency department, heart failure, mortality, triageAbstract
Introduction Acute heart failure (AHF) is a common condition among individuals who need medical attention at the emergency department (ED). The mainstay treatment of acute heart failure is diuretic therapy. Early intravenous (IV) diuretics may rapidly improve symptoms and clinical outcomes.
Objectives The study explored the effect of door-to-diuretics (D2D) time on mortality and other clinical outcomes in patients hospitalized with AHF.
Method A retrospective cohort study was conducted at Nakornping Hospital, using data from the hospital’s database center to evaluate the association between D2D time and all-cause in-hospital mortality as the primary outcome. Patients hospitalized with AHF and treated with IV diuretics within 24 hours of ED arrival between January 1, 2020, and September 30, 2022, were included, targeting a calculated sample size of 726. After applying the predefined exclusion criteria, eligible patients were categorized into an early treatment group (D2D time ≤60 minutes) and a non-early treatment group (D2D time >60 minutes).
Results A final analysis of 750 patients, the median D2D time was 65 minutes (IQR 43.75-108). Of the total number of patients, 343 (45.7%) were in the early treatment group, while 407 (54.3%) were in the non-early treatment group. All-cause in-hospital mortality was 16 cases (4.7%) and 24 cases (5.9%) respectively (p = 0.454). In a subgroup analysis for triage level 1, there was a trend toward a lower mortality rate in the early treatment group (11 out of 221, 5.0%) compared to the non-early treatment group (18 out of 165, 10.9%), p = 0.029.
Conclusion In summary, early IV diuretic therapy showed no significant mortality benefit but suggested a trend toward lower mortality in severe cases. Further research is needed to confirm and explore its potential benefits in AHF management.
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