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Intravenous fluids are frequently administered during early hospitalization in patients with acute heart failure who are receiving loop diuretics, and the practice is associated with worse outcomes, according to findings from a retrospective cohort study.
Of 131,430 hospitalizations for heart failure at 346 hospitals from 2009 to 2010, 13,806 (11%) involved administration of at least 500 mL of IV fluids during the first 2 days in patients on diuretics. Normal saline was used most often (80% of cases), followed by half-normal saline (12%), and the median administered volume was 1,000 mL.
Those who received fluids were significantly more likely than were those who did not to have subsequent critical care admission (odds ratio, 1.57), intubation (OR, 1.46), renal replacement therapy (OR, 2.04), and hospital death (OR, 2.02), reported Dr. Behnood Bikdeli of Yale New Haven (Conn.) Hospital, and colleagues. The report was published Feb. 2 in the Journal of the American College of Cardiology.
Wide variation was seen in the proportion of hospitalizations that used fluid treatment (range of 0% to 71%), the researchers noted (J. Am. Coll. Cardiol. HF 2015 Feb. 2 [doi:10.1016/j.jchf.2014.09.007]).
The use of IV fluids in heart failure patients on diuretics may be inadvertent given that “guidelines generally suggest fluid restriction for patients with heart failure and do not generally recommend intravenous fluid therapy,” the investigators noted, adding that the findings highlight an opportunity for improvement.
The study was funded by two of the National Institutes of Health as well as grants from the Patrick and Catherine Weldon Donaghue Medical Research Foundation in West Hartford, Ct. Dr. Bikdeli reported having no disclosures.
The finding by Bikdeli et al. that fluid administration is common in patients admitted to the hospital with heart failure points to a path forward with respect to improving acute care, according to Dr. Larry A. Allen.
“Now that this relatively common practice is revealed, it behooves us to better understand exactly why it is happening; this understanding can then guide efforts to extinguish truly inappropriate care,” he wrote (J. Am. Coll. Cardiol. HF 2015 Feb. 2 [doi:10.1016/j.jchf.2014.11.001]).
Particular attention should be paid to what matters most with respect to heart failure: a thoughtful approach to the control of fluid status, he said, adding that “good care is grounded in physiology, guided by evidence, and tailored to the patient.
“In the end, we deliver an incredible number and diversity of therapies well in the modern U.S. health care system. The pressing question is whether the totality of therapies makes sense in each individual,” he concluded.
Dr. Allen is with the University of Colorado, Aurora, and the Colorado Cardiovascular Outcomes Research Consortium, Denver. He disclosed funding from the National Heart, Lung, and Blood Institute.
The finding by Bikdeli et al. that fluid administration is common in patients admitted to the hospital with heart failure points to a path forward with respect to improving acute care, according to Dr. Larry A. Allen.
“Now that this relatively common practice is revealed, it behooves us to better understand exactly why it is happening; this understanding can then guide efforts to extinguish truly inappropriate care,” he wrote (J. Am. Coll. Cardiol. HF 2015 Feb. 2 [doi:10.1016/j.jchf.2014.11.001]).
Particular attention should be paid to what matters most with respect to heart failure: a thoughtful approach to the control of fluid status, he said, adding that “good care is grounded in physiology, guided by evidence, and tailored to the patient.
“In the end, we deliver an incredible number and diversity of therapies well in the modern U.S. health care system. The pressing question is whether the totality of therapies makes sense in each individual,” he concluded.
Dr. Allen is with the University of Colorado, Aurora, and the Colorado Cardiovascular Outcomes Research Consortium, Denver. He disclosed funding from the National Heart, Lung, and Blood Institute.
The finding by Bikdeli et al. that fluid administration is common in patients admitted to the hospital with heart failure points to a path forward with respect to improving acute care, according to Dr. Larry A. Allen.
“Now that this relatively common practice is revealed, it behooves us to better understand exactly why it is happening; this understanding can then guide efforts to extinguish truly inappropriate care,” he wrote (J. Am. Coll. Cardiol. HF 2015 Feb. 2 [doi:10.1016/j.jchf.2014.11.001]).
Particular attention should be paid to what matters most with respect to heart failure: a thoughtful approach to the control of fluid status, he said, adding that “good care is grounded in physiology, guided by evidence, and tailored to the patient.
“In the end, we deliver an incredible number and diversity of therapies well in the modern U.S. health care system. The pressing question is whether the totality of therapies makes sense in each individual,” he concluded.
Dr. Allen is with the University of Colorado, Aurora, and the Colorado Cardiovascular Outcomes Research Consortium, Denver. He disclosed funding from the National Heart, Lung, and Blood Institute.
Intravenous fluids are frequently administered during early hospitalization in patients with acute heart failure who are receiving loop diuretics, and the practice is associated with worse outcomes, according to findings from a retrospective cohort study.
Of 131,430 hospitalizations for heart failure at 346 hospitals from 2009 to 2010, 13,806 (11%) involved administration of at least 500 mL of IV fluids during the first 2 days in patients on diuretics. Normal saline was used most often (80% of cases), followed by half-normal saline (12%), and the median administered volume was 1,000 mL.
Those who received fluids were significantly more likely than were those who did not to have subsequent critical care admission (odds ratio, 1.57), intubation (OR, 1.46), renal replacement therapy (OR, 2.04), and hospital death (OR, 2.02), reported Dr. Behnood Bikdeli of Yale New Haven (Conn.) Hospital, and colleagues. The report was published Feb. 2 in the Journal of the American College of Cardiology.
Wide variation was seen in the proportion of hospitalizations that used fluid treatment (range of 0% to 71%), the researchers noted (J. Am. Coll. Cardiol. HF 2015 Feb. 2 [doi:10.1016/j.jchf.2014.09.007]).
The use of IV fluids in heart failure patients on diuretics may be inadvertent given that “guidelines generally suggest fluid restriction for patients with heart failure and do not generally recommend intravenous fluid therapy,” the investigators noted, adding that the findings highlight an opportunity for improvement.
The study was funded by two of the National Institutes of Health as well as grants from the Patrick and Catherine Weldon Donaghue Medical Research Foundation in West Hartford, Ct. Dr. Bikdeli reported having no disclosures.
Intravenous fluids are frequently administered during early hospitalization in patients with acute heart failure who are receiving loop diuretics, and the practice is associated with worse outcomes, according to findings from a retrospective cohort study.
Of 131,430 hospitalizations for heart failure at 346 hospitals from 2009 to 2010, 13,806 (11%) involved administration of at least 500 mL of IV fluids during the first 2 days in patients on diuretics. Normal saline was used most often (80% of cases), followed by half-normal saline (12%), and the median administered volume was 1,000 mL.
Those who received fluids were significantly more likely than were those who did not to have subsequent critical care admission (odds ratio, 1.57), intubation (OR, 1.46), renal replacement therapy (OR, 2.04), and hospital death (OR, 2.02), reported Dr. Behnood Bikdeli of Yale New Haven (Conn.) Hospital, and colleagues. The report was published Feb. 2 in the Journal of the American College of Cardiology.
Wide variation was seen in the proportion of hospitalizations that used fluid treatment (range of 0% to 71%), the researchers noted (J. Am. Coll. Cardiol. HF 2015 Feb. 2 [doi:10.1016/j.jchf.2014.09.007]).
The use of IV fluids in heart failure patients on diuretics may be inadvertent given that “guidelines generally suggest fluid restriction for patients with heart failure and do not generally recommend intravenous fluid therapy,” the investigators noted, adding that the findings highlight an opportunity for improvement.
The study was funded by two of the National Institutes of Health as well as grants from the Patrick and Catherine Weldon Donaghue Medical Research Foundation in West Hartford, Ct. Dr. Bikdeli reported having no disclosures.
Key clinical point: Patients hospitalized for heart failure may receive IV fluids inappropriately.
Major finding: Eleven percent of heart failure patients on diuretics received IV fluids during the first 2 inpatient days.
Data source: A retrospective cohort study of 131,430 hospitalizations.
Disclosures: The study was funded by two of the National Institutes of Health as well as grants from the Patrick and Catherine Weldon Donaghue Medical Research Foundation in West Hartford, Conn. Dr. Bikdeli reported having no disclosures.
