Intravenous fluids are frequently administered during early hospitalization in patients with acute heart failure who are receiving loop diuretics, and the practice is associated with worse outcomes, according to findings from a retrospective cohort study.
Of 131,430 hospitalizations for heart failure at 346 hospitals from 2009 to 2010, 13,806 (11%) involved administration of at least 500 mL of IV fluids during the first 2 days in patients on diuretics. Normal saline was used most often (80% of cases), followed by half-normal saline (12%), and the median administered volume was 1,000 mL.
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Those who received fluids were significantly more likely than were those who did not to have subsequent critical care admission (odds ratio, 1.57), intubation (OR, 1.46), renal replacement therapy (OR, 2.04), and hospital death (OR, 2.02), reported Dr. Behnood Bikdeli of Yale New Haven (Conn.) Hospital, and colleagues. The report was published Feb. 2 in the Journal of the American College of Cardiology.
Wide variation was seen in the proportion of hospitalizations that used fluid treatment (range of 0% to 71%), the researchers noted (J. Am. Coll. Cardiol. HF 2015 Feb. 2 [doi:10.1016/j.jchf.2014.09.007]).
The use of IV fluids in heart failure patients on diuretics may be inadvertent given that “guidelines generally suggest fluid restriction for patients with heart failure and do not generally recommend intravenous fluid therapy,” the investigators noted, adding that the findings highlight an opportunity for improvement.
The study was funded by two of the National Institutes of Health as well as grants from the Patrick and Catherine Weldon Donaghue Medical Research Foundation in West Hartford, Ct. Dr. Bikdeli reported having no disclosures.