SHM Converge Scientific Abstract ePoster Gallery-The Role of Titratable Diuresis Protocols for Treatment of Acute Decompensated Heart Failure

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This study evaluated a nurse-driven, titratable IV furosemide protocol for treating acute decompensated heart failure (ADHF), a condition that causes more than a million hospitalizations annually and often requires non-standardized diuretic dosing. Prior trials such as Yale Diuretic Pathway and ENACT-HF suggested that structured diuretic protocols can improve outcomes.<br /><br />At Corewell Health West–Butterworth Hospital, researchers retrospectively reviewed 1,254 ADHF hospitalizations. Patients were divided into a titratable IV furosemide protocol (TIFP) group of 880 patients and a standard care group of 374 patients. Under the protocol, nurses adjusted furosemide doses based on urine output over the previous four hours to optimize diuresis. Data collected included demographics, dosing, urine output, fluid balance, laboratory values, length of stay, and 30-day readmissions. A stratified, propensity-score-matched analysis was planned to compare outcomes.<br /><br />The primary outcome was hospital length of stay (LOS). The hospital’s prior average LOS goal was 6.64 days. Patients treated with the titratable protocol had an average LOS of 5.73 days, representing an improvement of about one day. Protocol adherence among the general hospitalist team was 71.6%, meeting the target usage rate of 70%.<br /><br />Secondary outcomes, including 30-day readmission, acute kidney injury, dialysis initiation, hypotension, electrolyte disturbances, and time to decongestion, were not yet available at the time of reporting.<br /><br />Overall, the findings suggest that a structured, nurse-driven, titratable IV diuretic protocol is feasible and may reduce hospital length of stay for patients with ADHF. Further statistical analysis is planned to better assess its impact on both primary and secondary outcomes.

Asset Subtitle

Mitchell Sarkisov

Meta Tag

Author List Jeremy J. Gentile, Kristen Buck, Melanie Mrozek, Mitchell Sarkisov, Mohamad El Shami, Sherilyn Munoz, Yajing Ji

Category Research

Concept Acute Decompensated Heart Failure

Concept IV Diuretic Dosing

Concept Hospital Length of Stay

Concept Nurse-Driven Protocol

Concept Torsemide

Distinguished Non-Finalist

Presenter Organization Corewell Health - Grand Rapids / MSUCHM

Presenting Author Mitchell Sarkisov

Track Outcomes Research

Keywords

acute decompensated heart failure

furosemide protocol

nurse-driven titration

intravenous diuretics

hospital length of stay

diuresis

propensity-score matching

protocol adherence

readmission

decongestion

Acute Decompensated Heart Failure

IV Diuretic Dosing

Hospital Length of Stay

Nurse-Driven Protocol

Torsemide