- A study published in the Journal of Cardiac Failure used Truveta Data to examine initial diuretic treatment strategies among more than 109,000 patients hospitalized for heart failure.
- Patients treated with more intensive diuretic strategies experienced greater weight loss during hospitalization, indicating more effective fluid removal. These strategies were also associated with higher rates of acute kidney injury.
- Regardless of treatment strategy, greater weight loss during hospitalization was associated with lower odds of readmission or death within 90 days.
Heart failure is one of the most common causes of hospitalization in the United States. A central goal of inpatient management is relieving congestion by removing excess fluid, typically through treatment with loop diuretics. While clinical guidelines provide general recommendations, clinicians use a wide range of dosing and combination strategies in practice, particularly for patients with more severe disease.
A new study published in the Journal of Cardiac Failure examined how different initial diuretic strategies were associated with fluid removal, kidney injury, and outcomes after discharge.
Study snapshot
Researchers identified more than 109,000 patients hospitalized for heart failure between 2015 and 2022 across US health systems in Truveta Data. Patients were grouped based on the most intensive diuretic strategy used within the first 48 hours of hospitalization, ranging from low-dose loop diuretics alone to high-dose loop diuretics combined with adjuvant therapies such as thiazides or acetazolamide.
Researchers examined weight loss, hemoconcentration, acute kidney injury during hospitalization, and the combined outcome of readmission or death within 90 days.
More intensive treatment was associated with greater fluid loss, but also higher rates of kidney injury
Patients treated with more intensive diuretic strategies also experienced greater weight loss during hospitalization, suggesting more effective removal of excess fluid. The largest reductions were observed among patients receiving high-dose loop diuretics combined with adjuvant therapy, with an adjusted average weight loss of 4.6 pounds.
However, more intensive treatment was also associated with higher rates of acute kidney injury during hospitalization, highlighting the clinical tradeoffs that can accompany more aggressive decongestion strategies.
Greater weight loss was associated with better outcomes after discharge
Despite greater weight loss during hospitalization, more intensive diuretic treatment strategies were not associated with lower odds of readmission or death within 90 days.
Researchers also evaluated weight loss itself, regardless of which diuretic strategy was used. They found that patients who lost more weight during hospitalization had lower odds of readmission or death within 90 days. Specifically, every five pounds of weight loss was associated with lower adjusted odds of the combined outcome.
This relationship was observed across treatment groups, suggesting that patients who lost more weight during hospitalization generally had better outcomes after discharge, regardless of how that weight loss was achieved.
Read the full study
Initial Diuretic Strategy During Hospitalization for Heart Failure and Associated Outcomes: Insights From the TREAT-AHF Registry, Journal of Cardiac Failure
