2022 Quality Summit ePosters (Non-CE) - General Quality Improvement-11. Protocolized Diuretic Management in Patients with Acute Decompensated Heart Failure: A Retrospective Analysis

11. Protocolized Diuretic Management in Patients with Acute Decompensated Heart Failure: A Retrospective Analysis

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This document summarizes a study conducted at Ascension St. Vincent Indianapolis to determine if the implementation of a diuretic protocol increased rates of decongestion in patients with acute decompensated heart failure (ADHF). The study included 75 patients and compared outcomes between a pre-protocol group and a post-protocol group.<br /><br />The diuretic protocol recommended furosemide dosing based on the patient's home diuretic dose. The primary outcome was the achievement of a urine output goal of 100-200 mL/hr within the first 24 hours of diuretic initiation. Secondary outcomes included diuretic dose adjustments, transition to oral diuretics, hospital length of stay, and rates of hypokalemia and hypotension.<br /><br />The study found that there was no statistically significant difference in goal urine output achievement between the pre-protocol and post-protocol groups. However, there were fewer patients in the post-protocol group who required diuretic dose increases or rescue diuretics. Additionally, patients in the post-protocol group transitioned to oral diuretics sooner and had a shorter hospital length of stay. The rates of hypokalemia and hypotension were higher in the post-protocol group.<br /><br />The study discussed the limited literature available on dosing IV diuretics in patients with ADHF. The small sample size of the study was noted as a limitation, as well as possible inconsistencies in charting urine output. The authors emphasized the importance of effective and expedient diuresis in improving patient outcomes and quality of life.<br /><br />Overall, while the diuretic protocol did not significantly increase rates of decongestion in ADHF patients, it showed some benefits in terms of reducing diuretic dose adjustments, facilitating transition to oral diuretics, and shortening hospital length of stay.

Keywords

Ascension St. Vincent Indianapolis

diuretic protocol

decongestion

acute decompensated heart failure

furosemide dosing

urine output goal

diuretic dose adjustments

transition to oral diuretics

hospital length of stay

hypokalemia and hypotension