Abstract 20613: Inadequate Loop Diuretic Dosing in Acute Heart Failure: A Missed Opportunity

Introduction: Loop diuretics are a mainstay of acute decompensated heart failure (ADHF) treatment in the Emergency Department (ED). Guidelines regarding the use of diuretics are variable, but most commonly include starting ED dosing at an equal or greater amount than the patient’s outpatient regimen, or giving ‘adequate amounts to achieve desired volume status’. The goal of this study was to characterize the variability of diuretic dosing in patients treated in the ED for recurrent ADHF in relationship to outpatient diuretic dose. Methods: Data were derived from a prospective observational study of patients with prior HF on home diuretics who were diagnosed and treated for ADHF in an urban, tertiary care ED between 2011 and 2013. Patients were excluded if they had a triage systolic blood pressure (SBP) < 95mmHg or were on hemodialysis. Patients were stratified based on initial diuretic dosing in relation to home diuretic dose. Results: Our study group of 247 patients had the following features: average ag...