Frequency of Transition to Oral Loop Diuretics Prior to Discharge

Introduction Heart failure guidelines recommend that patients with acute decompensated heart failure (ADHF) be transitioned to oral (PO) loop diuretics prior to discharge but little evidence supports this recommendation. Objectives We sought to identify the frequency that patients admitted for ADHF are transitioned to PO loop diuretics prior to discharge, identify predictors for transitioning to PO loop diuretics, and compare outcomes between patients converted to PO loop diuretics (PO group) to those who were not (IV group). Methods We conducted a retrospective chart review of unique adult patients hospitalized for ADHF at our facility between 9/1/2017 and 8/31/2019. Patients hospitalized for ADHF (ICD-10 I50.xx) with evidence of fluid overload, treated with IV loop diuretics during the first 24 hours of admission, and discharged home with a prescription for PO loop diuretic were included. Patients were excluded if they were on dialysis, left against medical advice, received palliative care referral while inpatient, or had a history of cirrhosis or received > 50mg of aldosterone antagonist a day. Patient demographics, clinical features, and practice patterns were characterized to identify predictors of PO transition. Thirty-day readmission rates were compared between the PO and IV groups. Results Among 240 patients included, 155 (65%) patients were transitioned to PO loop diuretics prior to discharge (PO group). Mean age was 63 years, most were men (55%) of African American (66%) descent. Compared to the IV group, the PO group had higher baseline potassium (4.3 vs 4.1 mEq/L, p=0.010), lower eGFR (52 vs 60 mL/min/1.73m2, p=0.016), were less likely to be on hydralazine (12.9% vs 24.7%, p=0.020), and more likely to be on a thiazide-type diuretic (9.7% vs 2.4%, p=0.034) on admission. Neither age, gender, blood pressure, renal function, nor electrolytes were significant predictors of transitioning to PO loop diuretics prior to hospital discharge. Within 30 days, 36 (23.2%) patients in the PO group were rehospitalized compared to 19 (22.4%) patients in the IV group (p=0.88). Conclusions Most patients admitted for ADHF were transitioned to PO loop diuretics prior to discharge. Although differences were noted in baseline characteristics, we did not identify any significant predictors for patients transitioned to PO diuretics. Thirty-day readmission rates were similar between patients who were and were not transitioned. Further study is warranted to identify the best approach for transitioning ADHF patients to PO diuretics prior to discharge.