Abstract 4143001: Rapid Diuresis Protocol in Decompensated Heart Failure: Improving Guideline-Directed Medical Therapy Titration and Timely Outpatient Follow-up

Current guidelines for treating acute decompensated heart failure (ADHF) recommend inpatient intravenous diuresis until congestion relief, as well as the initiation and advancement of guideline-directed medical therapy (GDMT). Our institution has developed a rapid diuresis team (RDT) to expedite decongestion in hospitalized ADHF patients with the goal of safely reducing length of stay. This study examines the RDT’s potential impact on GDMT titration as well as outpatient follow up timing. Does the RDT protocol improve GDMT titration and time to outpatient follow-up after discharge in patients with ADHF? This retrospective single-center study includes patients undergoing inpatient treatment for ADHF from March 2022 to November 2023 at a tertiary referral center. Demographic, clinical, and laboratory data were obtained. Standard parametric and non-parametric analyses were conducted, along with Kaplan-Meier curve analysis, with statistical significance set at p<0.05. The RDT protocol involves early aggressive diuresis with daily monitoring of weight, fluid intake, and urine output. Aggressive diuresis goals (3-4 L/day urine output) were set and included regular assessments by a multidisciplinary team. Discharge criteria focus on resting symptom resolution, adequate oral diuretic response, and an established follow-up within 3-5 days where GDMT can be adjusted as needed. Out of 255 patients, 128 underwent RDT and 127 received standard care. Patients in the RDT protocol had a shorter average time from hospital discharge to cardiology appointment (4 days vs. 5 days; p = 0.044). Additionally, those in the RDT protocol tended to have higher rates of follow-up within 30 days post-discharge (90% vs. 77%; p = 0.052) (Figure 1). GDMT titration prior to discharge was more common in the RDT group (93 vs. 74 patients; p = 0.025). At the follow-up visit, GDMT titration was also more frequent in the RDT group (55 vs. 43 patients; p = 0.207). Compared to standard care, the RDT protocol results in a shorter time to outpatient follow-up and improved inpatient and outpatient GDMT titration for the treatment of heart failure. The implementation of the RDT protocol appears to enhance the management and outcomes of patients with ADHF.