Effect of diuretic infusion clinic in preventing hospitalization for patients with decompensating heart failure

Background and Objectives Heart failure (HF) is a complex syndrome with multiple etiologies resulting in impaired ventricular filling or pumping of blood. HF is as a major public health concern that leads to significant morbidity and mortality resulting in an enormous financial burden on the healthcare system. The study objectives were to assess the 30-day hospital readmission rates and its financial impact on the hospital. Methods The study was a retrospective single-center analysis of decoded data of all HF patients admitted to an outpatient diuretic infusion program. Adult patients who were readmitted to the hospital within 30 days despite guideline derive medical therapy were included if they were enrolled in the outpatient diuretic infusion clinic. Adult patients who were included in this study received a furosemide dose of 40 mg intravenously (infusion over 3 hours) at the clinic visit. Patients whose clinical signs/symptoms improved and remained stable in consequent visits were eventually discharged from the clinic. Financial impact was assessed using data obtained from the hospital administration on cost of HF readmissions. Results The results show a 30-day hospital readmission rate at 6–9% in the years analyzed (n=56) with a net savings of $562,815 to $736,560 per year. Conclusions This treatment strategy has no detrimental effects in addition to generating substantial financial savings. It appears to be a useful addition to the existing medical treatment regimens chronic HF patients.

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“…However, there is no general consensus regarding the preferred mode of loop diuretics administered intravenously. 7) …”

Section: Introductionmentioning

confidence: 99%

Impact of Outpatient Diuretic Infusion Therapy on Healthcare Cost and Readmissions

et al. 2022

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“…Опыт работы зарубежных клиник, где терапия петлевыми диуретиками назначалась амбулаторному пациенту внутривенно при ухудшении клинического течения ХСН («diuretic infusion clinic», «diuretic lounge» и др. ), свидетельствует о том, что своевременная инициация или увеличение дозы петлевых диуретиков у пациента с утяжелением клинической симптоматики ХСН способны предотвратить формирование ОДСН и снизить риски госпитализации, что приведет к улучшению прогноза пациента [16,17]. Аналогичным образом, самоконтроль пациента и активное врачебно-фельдшерское наблюдение за пациентом с ХСН в специализированном мультидисциплинарном центре Нижнего Новгорода позволяет своевременно корректировать терапию основного заболевания, что приводит к снижению рисков смерти и повторной госпитализации в 2,8-3 раза [18,19].…”

Section: Discussionunclassified

Leading predictors of early and late hospital mortality among patients with acute decompensated heart failure and ways to improve prognosis

Поляков

Фомин

Vinogradova

et al. 2021

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Objective: to analyze the leading causes of early (first two days) and late (after the second day) hospital mortality among of patients with acute decompensated heart failure.Materials and methods: a retrospective single-center cohort (n=718) of patients with acute decompensated heart failure.Results: predictors of prognosis for early hospital mortality were pulmonary edema, hepatomegaly, the need for inotropic and vasopressive drugs, the level of systolic blood pressure and creatinine. Predictors of prognosis for late hospital mortality were pulmonary edema, the need for inotropic drugs, community-acquired pneumonia, and laboratory markers of acute renal injury.Conclusion: Tactical approaches are proposed to reduce hospital mortality of patients with acute decompensated heart failure.

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“…Whether intravenous therapy does necessitate admission varies between services, and many hospitals have well-established OPAT services, with pilot studies suggesting other intravenous treatments, including diuretics, could be delivered effectively in alternative settings, reducing hospitalisation. 35,36 Evaluation of score performance throughout the year is needed. The Amb Score was derived and validated from attendances in summer months.…”

Section: Limitations Of Scoring Systemsmentioning

confidence: 99%

How do we identify acute medical admissions that are suitable for same day emergency care?

2022

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Medical emergencies causing unplanned hospital admission place considerable demands on acute healthcare services. Some patients can be assessed and treated through ambulatory pathways without inpatient admission, via same day emergency care (SDEC), potentially benefiting patients and reducing demands on inpatient services. There is currently considerable variation within acute medicine in aspects of SDEC delivery ranging from overall service design to patient selection methods. Scoring systems identifying patients likely to be successfully managed through SDEC services have been suggested, but evidence of utility in diverse populations is lacking. Specific scoring systems exist for some common medical problems, including cardiac chest pain and pulmonary embolism, but further research is needed to demonstrate how these are most effectively incorporated into SDEC services. This review defines SDEC and describes the variation in services nationally. It reviews the evidence for their clinical impact, tools to screen patients for SDEC and current gaps in our knowledge regarding service deployment.

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Effect of diuretic infusion clinic in preventing hospitalization for patients with decompensating heart failure

Cited by 4 publications

References 17 publications

Impact of Outpatient Diuretic Infusion Therapy on Healthcare Cost and Readmissions

Impact of Outpatient Diuretic Infusion Therapy on Healthcare Cost and Readmissions

Leading predictors of early and late hospital mortality among patients with acute decompensated heart failure and ways to improve prognosis

How do we identify acute medical admissions that are suitable for same day emergency care?

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