SHM Converge Scientific Abstract ePoster Gallery-Is the Juice Worth the Squeeze: Exploring Adequacy of Diuresis in Acute Decompensated Heart Failure Hospitalizations

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This retrospective chart review examined 73 heart failure patients discharged from Thomas Jefferson University Hospital in August 2024 who required IV diuretics, with the goal of establishing a baseline for future quality improvement efforts.<br /><br />Key findings showed room for improvement in early and ongoing diuretic management:<br />- Only 28 patients (38%) received an IV diuretic in the emergency department.<br />- The average initial ED dose was 111% of the target dose, but dosing varied widely (10% to 400% of goal), suggesting inconsistency despite an overall acceptable mean.<br />- Average door-to-diuretic time was 4.03 hours, with only 7% of doses given within 60 minutes of presentation, which is much slower than recommended benchmarks.<br />- Across 241 total IV diuretic days, only 32% met the study’s definition of adequate diuresis.<br /><br />Markers of diuresis before discharge also suggested incomplete decongestion:<br />- 56% of patients left with a discharge weight below their admission floor weight.<br />- 23% showed hemoconcentration by hemoglobin.<br />- 21% showed hemoconcentration by albumin.<br />- The average weight change was -2.6%.<br /><br />The authors conclude that there are concerns about recognition of acute decompensated heart failure at presentation, timing of the first IV diuretic dose, and consistency of dose selection. They also suggest that inpatient teams may need to pursue more aggressive daily diuresis and greater fluid removal before discharge to reduce readmissions and improve outcomes. These data will serve as a baseline for targeted systems interventions and future comparison.

Asset Subtitle

Sheraz Qamar

Meta Tag

Author List Alan A. Kubey, Avish Patel, Benjamin Richter, Comfort Elumogo, Joshua Riley, Katherine Freedberg, Marina Gonzalez, Meiqi Luo, Ryan Gardner, Sheraz Qamar, Virginia Gonzalez

Category Research

Concept Acute Decompensated Heart Failure

Concept Door-to-Diuretic Time

Concept IV Diuretics

Concept Urine Output

Concept Net Fluid Loss

Distinguished Non-Finalist

Presenter Organization Thomas Jefferson University Hospital

Presenting Author Sheraz Qamar

Track Quality Improvement

Keywords

heart failure

retrospective chart review

intravenous diuretics

acute decompensated heart failure

emergency department

door-to-diuretic time

diuresis

decongestion

quality improvement

hospital discharge

Acute Decompensated Heart Failure

Door-to-Diuretic Time

IV Diuretics

Urine Output

Net Fluid Loss