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Outpatient Intravenous Diuretic Clinic: An Effective Strategy for Management of Volume Overload and Reducing Immediate Hospital Admissions

BACKGROUND: Heart failure (HF) readmissions pose a major burden to patients and the healthcare system. We evaluated whether outpatient intravenous (IV) diuretic clinic is a safe and effective strategy to reduce HF hospitalizations. METHODS: We reviewed 34 clinic encounters with 27 unique patients (m...

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Autores principales: Verma, Vivek, Zhang, Manling, Bell, Marilyn, Tarolli, Karen, Donalson, Elinor, Vaughn, Jamie, Hickey, Gavin W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elmer Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8110218/
https://www.ncbi.nlm.nih.gov/pubmed/34007363
http://dx.doi.org/10.14740/jocmr4499
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author Verma, Vivek
Zhang, Manling
Bell, Marilyn
Tarolli, Karen
Donalson, Elinor
Vaughn, Jamie
Hickey, Gavin W.
author_facet Verma, Vivek
Zhang, Manling
Bell, Marilyn
Tarolli, Karen
Donalson, Elinor
Vaughn, Jamie
Hickey, Gavin W.
author_sort Verma, Vivek
collection PubMed
description BACKGROUND: Heart failure (HF) readmissions pose a major burden to patients and the healthcare system. We evaluated whether outpatient intravenous (IV) diuretic clinic is a safe and effective strategy to reduce HF hospitalizations. METHODS: We reviewed 34 clinic encounters with 27 unique patients (median age 72) who had volume overload refractory to oral diuretics that were treated with IV furosemide in the outpatient clinic. One patient (2.9%) was admitted to the hospital directly, and the rest were discharged home. RESULTS: More than 80% of the patients had continued weight loss for 7 days (median weight loss 5.4 lb). During the median follow-up period of 15 months, 15 patients (56%) had subsequent HF hospitalizations. HF admission was delayed by a median of 22 days from the clinic visit and 138 days from the previous HF admission prior to clinic visit. Estimated cost saving per admission avoided was $10,395. One patient developed severe hypokalemia (< 3.0 mmol/L), and the remaining had no adverse events. CONCLUSION: Outpatient IV diuresis is effective and well tolerated. It leads to significant weight loss, persisting in the majority of patients for 7 days. In select patients, it should be considered as a strategy to rapidly improve symptoms, reduce hospitalizations and decrease costs.
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spelling pubmed-81102182021-05-17 Outpatient Intravenous Diuretic Clinic: An Effective Strategy for Management of Volume Overload and Reducing Immediate Hospital Admissions Verma, Vivek Zhang, Manling Bell, Marilyn Tarolli, Karen Donalson, Elinor Vaughn, Jamie Hickey, Gavin W. J Clin Med Res Original Article BACKGROUND: Heart failure (HF) readmissions pose a major burden to patients and the healthcare system. We evaluated whether outpatient intravenous (IV) diuretic clinic is a safe and effective strategy to reduce HF hospitalizations. METHODS: We reviewed 34 clinic encounters with 27 unique patients (median age 72) who had volume overload refractory to oral diuretics that were treated with IV furosemide in the outpatient clinic. One patient (2.9%) was admitted to the hospital directly, and the rest were discharged home. RESULTS: More than 80% of the patients had continued weight loss for 7 days (median weight loss 5.4 lb). During the median follow-up period of 15 months, 15 patients (56%) had subsequent HF hospitalizations. HF admission was delayed by a median of 22 days from the clinic visit and 138 days from the previous HF admission prior to clinic visit. Estimated cost saving per admission avoided was $10,395. One patient developed severe hypokalemia (< 3.0 mmol/L), and the remaining had no adverse events. CONCLUSION: Outpatient IV diuresis is effective and well tolerated. It leads to significant weight loss, persisting in the majority of patients for 7 days. In select patients, it should be considered as a strategy to rapidly improve symptoms, reduce hospitalizations and decrease costs. Elmer Press 2021-04 2021-04-27 /pmc/articles/PMC8110218/ /pubmed/34007363 http://dx.doi.org/10.14740/jocmr4499 Text en Copyright 2021, Verma et al. https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Verma, Vivek
Zhang, Manling
Bell, Marilyn
Tarolli, Karen
Donalson, Elinor
Vaughn, Jamie
Hickey, Gavin W.
Outpatient Intravenous Diuretic Clinic: An Effective Strategy for Management of Volume Overload and Reducing Immediate Hospital Admissions
title Outpatient Intravenous Diuretic Clinic: An Effective Strategy for Management of Volume Overload and Reducing Immediate Hospital Admissions
title_full Outpatient Intravenous Diuretic Clinic: An Effective Strategy for Management of Volume Overload and Reducing Immediate Hospital Admissions
title_fullStr Outpatient Intravenous Diuretic Clinic: An Effective Strategy for Management of Volume Overload and Reducing Immediate Hospital Admissions
title_full_unstemmed Outpatient Intravenous Diuretic Clinic: An Effective Strategy for Management of Volume Overload and Reducing Immediate Hospital Admissions
title_short Outpatient Intravenous Diuretic Clinic: An Effective Strategy for Management of Volume Overload and Reducing Immediate Hospital Admissions
title_sort outpatient intravenous diuretic clinic: an effective strategy for management of volume overload and reducing immediate hospital admissions
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8110218/
https://www.ncbi.nlm.nih.gov/pubmed/34007363
http://dx.doi.org/10.14740/jocmr4499
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