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Evaluating the Efficacy of a Standardized Diuretic Order Panel versus Provider-Prescribed Diuretic Dosing in Acute Decompensated Heart Failure (ADHF)
Friday April 25, 2025 11:20am - 11:35am EDT
Athena I
Evaluating the Efficacy of a Standardized Diuretic Order Panel versus Provider-Prescribed Diuretic Dosing in Acute Decompensated Heart Failure (ADHF)
Yanise Hurt, Jarvett Cox
 
 
Background: Acute decompensated heart failure (ADHF) is a leading cause of hospitalization, often driven by fluid overload. Effective diuresis is critical 
to improving clinical outcomes in this population; however, variability in prescribing practices can lead to inconsistent care and suboptimal results. The 
implementation of a standardized Heart Failure Diuresis Panel offers an evidence-based approach to diuretic therapy, promoting consistent and effective fluid removal while potentially reducing hospital length of stay. This study aimed to evaluate the clinical outcomes of ADHF patients treated with diuretics using a standardized panel compared to those managed with individualized provider-prescribed dosing, focusing on its impact on hospital length of stay.
 
Methodology: This retrospective, single-center chart review included 168 adult patients admitted with a primary diagnosis of ADHF at Wellstar Cobb Medical Center between January 1, 2023, and December 31, 2023. Patients were stratified into two groups based on their diuretic management: those who 
received therapy guided by the standardized Heart Failure Diuresis Panel and those managed with provider-prescribed dosing. The primary endpoint of
 the study was hospital length of stay. Secondary endpoints included the mean time to transition from intravenous (IV) to oral diuretics, door-to-diuretic 
time, 30-day heart failure readmission rates, mean changes in urine output and body weight, and diuretic prescriptions at discharge. Data was extracted from electronic medical records through a computer-generated report, and statistical analyses were conducted using t-tests for continuous variables and chi-square tests for categorical variables to evaluate the impact of the standardized panel on clinical outcomes.
 
Results: In the comparison of patients managed with the Heart Failure Diuresis Panel versus provider-prescribed diuretic dosing, there was no significant difference in hospital length of stay (4.79 days vs. 4.75 days; P=0.47) or in the mean time to transition from IV to PO diuretics (68.9 hours vs. 68.4 hours; P=0.23). Similarly, door-to-diuretic time (7.1 hours vs. 7.7 hours; P=0.41), 30-day heart failure readmission rates (8.3% vs. 9.5%; P=0.79), and diuretic 
prescription rates at discharge (85.7% vs. 76.2%; P=0.35) did not differ significantly between groups. However, the panel group demonstrated significantly greater mean urine output at 24 hours (1,584 mL vs. 1,283 mL; P=0.048), indicating enhanced diuretic responsiveness, though no significant differences were observed at 2 or 48 hours. The mean change in body weight was comparable between groups both at 24 hours (0.86 kg vs. 0.50 kg; P=0.29) and at discharge (3.07 kg vs. 2.62 kg; P=0.35). Although the standardized panel did not significantly affect hospital length of stay or most secondary 
measures, it was associated with improved early diuretic efficacy as demonstrated by greater urine output within the first 24 hours.
 
Conclusion: The Heart Failure Diuresis Panel did not demonstrate a significant impact on primary or secondary outcomes, including hospital length of 
stay. However, the consistent administration of appropriate IV diuretic dosing by providers not utilizing the panel suggested that its core principles have been effectively integrated into routine clinical practice. These findings are consistent with the DOSE trial, which underscores the importance of optimized diuretic strategies for symptom relief and fluid management in heart failure. This presents an opportunity to improve provider adherence to these 
protocols, potentially further optimizing patient outcomes.
Moderators
AP
Presenters
avatar for Yanise Hurt

Yanise Hurt

PGY1 Resident, Wellstar Cobb Medical Center
My name is Yanise Hurt. I am a PGY1 Resident at Wellstar Cobb Medical Center, with a Doctor of Pharmacy degree from Philadelphia College of Osteopathic Medicine and a Master of Public Health from Georgia Southern University.
Evaluators
avatar for Robin Fischer

Robin Fischer

PGY1 Pharmacy Practice Resident, MRMC1McLeod Regional Medical CenterPGY1
Hello my name is Robin Fischer and I am one of the PGY1 pharmacy practice preceptors / mentors at McLeod Regional Medical Center. I am a retired deputy sheriff from Charleston County Sheriff's Office and I obtained a bachelor’s degree in Criminal Justice Administration. Once I retired... Read More →
Friday April 25, 2025 11:20am - 11:35am EDT
Athena I
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