Intravenous fluids in acute decompensated heart failure

Behnood Bikdeli, Kelly M. Strait, Kumar Dharmarajan, Shu Xia Li, Purav Mody, Chohreh Partovian, Steven G. Coca, Nancy Kim, Leora I. Horwitz, Jeffrey M. Testani, Harlan M. Krumholz

Research output: Contribution to journalArticle

25 Scopus citations

Abstract

Objectives: This study sought to determine the use of intravenous fluids in the early care of patients with acute decompensated heart failure (HF) who are treated with loop diuretics. Background: Intravenous fluids are routinely provided to many hospitalized patients. Methods: We conducted a retrospective cohort study of patients admitted with HF to 346 hospitals from 2009 to 2010. We assessed the use of intravenous fluids during the first 2 days of hospitalization. We determined the frequency of adverse in-hospital outcomes. We assessed variation in the use of intravenous fluids across hospitals and patient groups. Results: Among 131,430 hospitalizations for HF, 13,806 (11%) were in patients treated with intravenous fluids during the first 2 days. The median volume of administered fluid was 1,000 ml (interquartile range: 1,000 to 2,000 ml), and the most commonly used fluids were normal saline (80%) and half-normal saline (12%). Demographic characteristics and comorbidities were similar in hospitalizations in which patients did and did not receive fluids. Patients who were treated with intravenous fluids had higher rates of subsequent critical care admission (5.7% vs. 3.8%; p< 0.0001), intubation (1.4% vs. 1.0%; p= 0.0012), renal replacement therapy (0.6% vs. 0.3%; p< 0.0001), and hospital death (3.3% vs. 1.8%; p< 0.0001) compared with those who received only diuretics. The proportion of hospitalizations that used fluidtreatment varied widely across hospitals (range: 0% to 71%; median: 12.5%). Conclusions: Many patients who are hospitalized with HF and receive diuretics also receive intravenous fluids duringtheir early inpatient care, and the proportion varies among hospitals. Such practice is associated with worse outcomes and warrants further investigation.

Original languageEnglish (US)
Pages (from-to)127-133
Number of pages7
JournalJACC: Heart Failure
Volume3
Issue number2
DOIs
StatePublished - Feb 1 2015

Keywords

  • Diuretics
  • HF
  • Heart failure
  • ICD-9-CM
  • Intravenous fluids

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Bikdeli, B., Strait, K. M., Dharmarajan, K., Li, S. X., Mody, P., Partovian, C., Coca, S. G., Kim, N., Horwitz, L. I., Testani, J. M., & Krumholz, H. M. (2015). Intravenous fluids in acute decompensated heart failure. JACC: Heart Failure, 3(2), 127-133. https://doi.org/10.1016/j.jchf.2014.09.007