Outpatient versus inpatient intravenous diuretic therapy for heart failure in the United States

Greene, Stephen J.; Goto, Daisuke; Wang, Dong; Hilkert, Robert; Lautsch, Dominik; Fonarow, Gregg C.

doi:10.1002/ejhf.2727

Cited by 4 publications

(7 citation statements)

References 8 publications

(14 reference statements)

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“…regional differences in healthcare structure and management protocols of the outpatient HF clinic would have a major impact on the incidence of the outcome). 18,19…”

Section: Future Directions In Randomized Clinical Trialsmentioning

confidence: 99%

“…Including WHF in the outpatient clinic as an outcome may surely lead to an increase in event rates in the composite endpoint, although this might rather dilute the treatment effect for some drugs, and may become an outcome dependent on healthcare systems (i.e. regional differences in healthcare structure and management protocols of the outpatient HF clinic would have a major impact on the incidence of the outcome) 18,19 …”

Section: Future Directions In Randomized Clinical Trialsmentioning

confidence: 99%

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Worsening heart failure comes into focus, chronic heart failure takes a backseat

González‐Del‐Hoyo,

Rossello

2024

European J of Heart Fail

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This article refers to 'The different risk of new-onset, chronic, worsening, and advanced heart failure: A systematic review and meta-regression analysis' by A. Shakoor et al., published in this issue on pages 216-229.Heart failure (HF) is a progressive and complex disease with a substantial variability in risk over time. 1 Once new-onset HF is diagnosed, periods of clinical stability defined as chronic HF (CHF) with a reduced residual risk under aggressive use of guideline-directed medical therapy (GDMT), may be disrupted by episodes of worsening HF (WHF). 2,3 Indeed, WHF episodes are markers of increased clinical risk which lastly progress to advanced HF refractory to GDMT. After decades improving the therapeutic armamentarium for CHF patients, a higher acknowledgement of the severity of WHF and new-onset HF should put the focus into a different type of patient with a higher underlying risk.In this issue of the Journal, Shakoor and colleagues 4 present the results of a comprehensive meta-regression-analysis of 66 contemporary observational studies evaluating 860 112 HF patients grouped into four different stages: new-onset HF (576 897 patients [67.1%]), CHF (203 651 [23.7%]), WHF (71 555 [8.3%]) and advanced HF (8009 [0.9%]). After pooling the data, they found that 1-year mortality was highest in patients with advanced HF (29.7%), followed closely by WHF (26.8%), new-onset HF (21.2%) and CHF (8.5%). These findings highlight that 'stable' CHF patients have better prognosis compared with 'unstable' (new-onset HF and WHF) as they have already survived an initial critical phase after diagnosis (survivor bias), 5 while unstable patients are in a turning point of the HF clinical course.

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“…regional differences in healthcare structure and management protocols of the outpatient HF clinic would have a major impact on the incidence of the outcome). 18,19…”

Section: Future Directions In Randomized Clinical Trialsmentioning

confidence: 99%

Section: Future Directions In Randomized Clinical Trialsmentioning

confidence: 99%

Worsening heart failure comes into focus, chronic heart failure takes a backseat

González‐Del‐Hoyo,

Rossello

2024

European J of Heart Fail

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“…1,2 Despite these therapeutic advances, many patients with HFrEF continue to deteriorate and experience worsening heart failure events (WHFE) with subsequent use of intravenous diuretic therapy in the outpatient, inpatient, and emergency department settings. [3][4][5] These patients have a high co-morbidity burden, increased risk of symptom worsening, decreased survival, and greater healthcare costs compared with patients with HFrEF without WHFE. 3,4,[6][7][8] While treatment with multiple agents has been shown to improve the outcomes of patients with HFrEF with WHFE in clinical trials, there remains a need to understand the use of these effective treatments in routine clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Treatment patterns of patients with worsening heart failure with reduced ejection fraction

Greene,

Gaggin,

Zhou

et al. 2024

ESC Heart Failure

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AimsPatients with HFrEF and worsening HF events (WHFE) are at particularly high risk and urgently need disease‐modifying therapy. CHART‐HF assessed treatment patterns and reasons for medication decisions among HFrEF patients with and without WHFE.Methods and resultsCHART‐HF collected retrospective electronic medical records of outpatients with HF and EF < 45% between 2017–2019 from a nationwide panel of 238 cardiologists (458 patients) and the Geisinger Health System (GHS) medical record (1000 patients). The index visit in the WHFE cohort was the first outpatient cardiologist visit ≤6 months following the WHFE, and in the reference cohort was the last visit in a calendar year without WHFE. Demographic characteristics were similar between patients with and without WHFE in both the nationwide panel and GHS. In the nationwide panel, the proportion of patients with versus without WHFE receiving ≥50% of guideline‐recommended dose on index visit was 35% versus 40% for beta blocker, 74% versus 83% for ACEI/ARB/ARNI, and 48% versus 49% for MRA. The proportion of patients receiving ≥50% of guideline‐recommended dose was lower in the GHS: 29% versus 34% for beta‐blocker, 16% versus 31% for ACEI/ARB/ARNI, and 18% versus 22% for MRA. For patients with and without WHFE, triple therapy on index date was 42% and 44% of patients from the nationwide panel, and 14% and 17% in the GHS. Comparing end of index clinic visit with 12‐month follow‐up in the GHS, the proportion of patients on no GDMT increased from 14% to 28% in the WHFE cohort and from 14 to 21% in the non‐WHFE group.ConclusionsMajor gaps in use of GDMT, particularly combination therapy, remain among US HFrEF patients. These gaps persist during longitudinal follow‐up and are particularly large among patients with recent WHFE.

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Section: Introductionmentioning

confidence: 99%

“…6 Among patients on Medicare, fewer than 1% of all CHF visits in the US are for outpatient IV diuresis, and among all visits specifically for the purpose of diuresis, outpatient IV diuresis accounts for no more than 15% of the total. 6,7 One of the challenges in reducing the burden and consequences of hospitalizations for a CHF exacerbation lies in being able to identify at presentation patients who medically are both not so acutely ill that outpatient management is obviously contraindicated, but who are at the same time at low risk for progression while hospitalized (ie, those for whom outpatient management would be adequate). Hence, we set out to define a group of short-stay CHF inpatients in the US hospitals whose sole reason for the admission is IV diuresis (CHF-L).…”

Section: Introductionmentioning

confidence: 99%

Examining the Burden of Potentially Avoidable Heart Failure Hospitalizations

Zilberberg,

Nathanson,

Sulham

et al. 2023

CEOR

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Background Two-thirds of the 1 million annual US CHF hospitalizations are for diuresis only; some may be avoidable. We describe a population of low-severity short-stay (2. We compared baseline characteristics, processes of care, and outcomes in low-severity (CHF-L) to CHF-H. Results Among 301,672 short-stay CHF patients, 135,304 (44.8%) were CHF-L. Compared to CHF-H, CHF-L was younger (70.5 ± 14.1 vs 72.1 ± 13.6 years, p < 0.001), more commonly female (48.6% vs 45.8%, p < 0.001), and more likely to receive IV ACE-I/ARB agents (0.5% vs 0.4%, p = 0.003). Most other IV medications were more common in CHF-H, and anticoagulation was the most prevalent non-diuretic IV therapy in both groups (23.8% vs 33.3%, p < 0.001). Hospital mortality (0.2% vs 1.5%, p < 0.001) and CHF-related 30-day readmissions (8.1% vs 10.5%, p < 0.001) were lower in CHF-L than CHF-H. Conclusion Among short-stay CHF patients, nearly ½ meet criteria for CHF-L, and are mainly admitted for fluid management. Avoiding these admissions could result in substantial savings.

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Outpatient versus inpatient intravenous diuretic therapy for heart failure in the United States

Cited by 4 publications

References 8 publications

Worsening heart failure comes into focus, chronic heart failure takes a backseat

Worsening heart failure comes into focus, chronic heart failure takes a backseat

Treatment patterns of patients with worsening heart failure with reduced ejection fraction

Examining the Burden of Potentially Avoidable Heart Failure Hospitalizations

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