2026 Eastern States Conference

Authors
Sunkyu Han PharmD; Emily Gill PharmD, BCCCP; Bethany Rennie PharmD 
 
Learning Objective  
Compare all-cause 30-day readmission rates for patients hospitalized with acute decompensated heart failure (ADHF) who are discharged on optimized versus non-optimized loop diuretic doses. 
 
Self-Assessment Question
For patients who are admitted for ADHF on a loop diuretic prior to admission, what diuretic intervention may reduce the risk of 30-day readmission?
A. Maintain patients on the same loop diuretic dose
B. Switch to another class of diuretics
C. Increase the loop diuretic dose and discharge patients on the higher dose
D. Decrease the loop diuretic dose and discharge patients on the lower dose

Background/Objective
Loop diuretics are the therapy of choice for symptom management in ADHF. The objective of this study was to identify whether optimization of loop diuretic dose at hospital discharge lowers the risk of 30-day all-cause hospital readmission.  
 
Methods
This was a multicenter, retrospective cohort study. Adult patients admitted to the hospital due to ADHF between 12/1/2023 and 12/31/2024 were included if they had a left ventricular ejection fraction ≤40% and were prescribed a loop diuretic prior to admission (PTA). Patients who received renal replacement therapy, were admitted to the intensive care unit, or died during the admission were excluded. Patients were divided into 2 groups: diuretic dose optimized (discharged on a higher dose than the PTA dose) and non-optimized (discharged on the same or decreased dose than the PTA dose). The primary outcome was 30-day all-cause readmission. Secondary outcomes were 30-day heart failure readmission and 30-day mortality. Descriptive statistics were utilized to summarize the study variables, and a multivariable logistic regression model was constructed to identify the association between baseline characteristics and 30-day all-cause readmission. 
 
Results  
A total of 300 patients were included in the study; 130 in the optimized dose group and 170 in the non-optimized dose group. Diuretic optimization was associated with a significantly lower rate of 30-day all-cause hospital readmission compared to non-optimization (21.6% versus 43.7%; p=0.01). The rate of 30-day heart failure readmission was also significantly lower in the optimized group compared to the non-optimized group (8.5% versus 16.5%; p=0.04), but 30-day mortality was similar between groups (3.1% versus 1.8%; p=0.46). Diuretic dose optimization on discharge was independently associated with a lower risk of 30-day all-cause hospital readmission (OR 0.55, 95% CI 0.33-0.95, p=0.03). 
 
Conclusion
For patients hospitalized due to ADHF, diuretic dose optimization at discharge may decrease the risk of 30-day all-cause hospital readmission. However, due to the small sample size and retrospective design of this study, larger, randomized, prospective studies should be conducted to further validate these findings.