Title: Comparing 30-day readmission rates with varying diuresis strategies in heart failure exacerbation Authors: Kaitlyn Burchett, PharmD; Jaclyn Collier, PharmD; Brian Burton, MS; Michael Czupryn, PharmD, BCPS Learning Objective: Explain the potential implications of diuresing until achieving a rise in serum creatinine during an acute heart failure exacerbation. Self-assessment Question: How can the achievement of a serum creatinine rise while diuresing during a heart failure exacerbation impact the guideline-directed medical therapy prescribed at discharge? Background/Objective: Guidance on how to diurese patients with heart failure (HF) exacerbations exists but does not address determining euvolemia. The aim of this study was to assess the effect of diuresing until a serum creatinine rise and its impact on HF readmissions. Methods: Medical records of patients aged 18 years or older admitted to non-intensive care units at Charleston Area Medical Center Memorial Hospital with an acute left-sided heart failure exacerbation from January 1st, 2024, to January 1st, 2025, were retrospectively reviewed. Records were selected by relevant ICD.10 codes and included the entire spectrum of ejection fractions. Thirty-day readmission rates and lengths of stay were compared between patients who did and did not achieve an increase in serum creatinine (SCr) of at least 0.3 mg/dL from the lowest documented SCr during the qualifying admission. Results: Out of the 1453 patients reviewed, 479 met inclusion criteria. Of those included, 141 achieved a bump in SCr. This increase in SCr resulted in a higher readmission rate than not achieving an increase (19.1% vs. 16.0%; P=NS) and was associated with a lower likelihood of being discharged on all components of guideline-directed medical therapy (GDMT) for heart failure. Length of stay was significantly shorter for patients without a SCr bump (6.8 days vs. 6.2 days; P=0.0152). Conclusions: In patients with acute left-sided HF exacerbations, diuresing with intravenous loop diuretics until achievement of an increase in SCr does not appear to positively impact HF readmission rates and may negatively influence the GDMT patients are prescribed at discharge. Thus, this diuretic strategy cannot be recommended at this time.
