Combining decongestion markers may guide HF hospital discharge

By Eleanor McDermid

Patients hospitalised with acute heart failure (HF) who achieve good haemoconcentration in addition to a robust diuretic response are unlikely to be rehospitalised within the following 2 months, research suggests.

Adriaan Voors (University Medical Center Groningen, the Netherlands) and co-researchers concede that the value of adding these parameters to established risk prediction models was "limited", offering only a small, albeit statistically significant, improvement in accuracy.

But they say: "Both diuretic response and hemoconcentration are easily calculated using data collected during routine care, and they are more accessible and applicable than elaborate risk models."

Among 1180 patients in the PROTECT trial, those with above-median diuretic responses (weight loss >0.36 kg/40 mg furosemide) and haemoconcentration (>0.2 g/L) had the lowest risk of rehospitalisation after accounting for factors such as age, previous hospitalisations and study treatment.

Other patients had more than double the risk of 60-day rehospitalisation for any cause, even if they had an above-median response on one of these parameters, with hazards ranging from 2.21 to 2.66. And there were similar findings for rehospitalisation for renal or cardiovascular causes, with hazard ratios of between 1.87 and 2.10.

"Thus, examining both decongestive markers may provide an easy accessible and relevant tool for clinicians to identify patients at particularly low risk of rehospitalization, with the potential for easing the burden on already overburdened healthcare systems", write Voors et al in Circulation: Heart Failure.

They say that if a physician is considering discharging an HF patient after a good response to diuretic treatment, additional assessment of haemoconcentration may help to confirm the decision.

"In the presence of hemoconcentration, this patient can be relatively safely discharged, with a low risk of HF rehospitalisation", the team writes. "However, the absence of hemoconcentration may trigger the clinician to re-evaluate his decision, and assess signs and symptoms again, and for instance prolong diuretic treatment for a while longer."

The researchers confirmed their findings in an additional 1776 patients from the EVEREST trial, achieving similar results, although with smaller hazard ratios overall, which rendered the differences in 60-day renal/cardiovascular hospitalisation nonsignificant.

They believe this to be due to differences in the study populations, with PROTECT patients generally being older and more poorly than EVEREST patients, with a poorer response to diuretics.

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Circ Heart Fail 2016; Advance online publication


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