The Efficacy, Safety, And Cost Savings Of High Dose IV Diuretics For Heart Failure Patients In An Outpatient Setting With Limited Hospital Bed Space Due To Covid-19

INTRODUCTION: Hospitalization is the greatest expenditure for heart failure treatment, estimated to be 8-15 billion dollars annually with the most common cost due to acute decompensation. An approach to manage this is an infusion clinic for outpatient diuresis and observation is an effective way to reduce the admission rate and improve patient outcomes. There are limited studies about high dose IV diuretics for outpatient treatment and outcomes. Bed availability during 2021 was severely limited due to COVID, and sicker patients were cared for outside of conventional hospital treatment. HYPOTHESIS: High dose IV diuretics for heart failure patients in an infusion clinic can reduce admission rate effectively and safely. METHODS: Patient medical records were retrospectively reviewed. 83 patients with symptomatic decompensation underwent 117 treatments in 2021. They received an individualized, protocol driven bolus and infusion of IV diuretics at the clinic calculated on their baseline diuretic dosing. All but one patient was seen in follow up in 2 business days. Outcomes measured included hospital admission within 30 days, hospital days avoided, and costs saved. Adverse outcomes monitored included acute kidney injury, hypokalemia, symptomatic hypotension, and arrhythmia. RESULTS: The patients had an average age of 73.6+/-12.9 years old, 64% male and 36% female. There were 80% of patients with HFpEF. The average weight gain above dry weight was 14.6 pounds. The patients had multiple comorbidities and all have chronic kidney disease stage 3 or higher. They were all on high dose diuretics. The results showed that following treatment the admission rate was 47% with 78% of those diagnosed with heart failure exacerbation. Only 1 patient was hospitalized for AKI and hypokalemia. Two patients had transient AKI at follow-up which resolved with diuretic adjustment. Estimated hospital days avoided was 372 days with a savings of 413,168 dollars based on FY21 direct cost/case. CONCLUSION: COVID-19 significantly limited the ability to provide care for patients with chronic issues in the hospital due to bed availability. Avoiding inpatient admissions on a medically complex, congested group of patients results in a significant cost saving while providing safe and effective care.