Impact of Transitioning Patients to Oral Diuretics 24 Hours Before Discharge from Heart Failure Hospitalization on 30 Day Outcomes

Patients hospitalized for heart failure (HF) are at high risk for post-discharge events. Although transition from intravenous to oral diuretic therapy for > 24 hours is commonly practiced to reduce post-discharge risk, evidence supporting this strategy is limited. We investigated the impact of this practice on 30 day post-discharge outcomes following HF hospitalization at our institution.Retrospective chart review of patients hospitalized with a primary HF diagnosis, discharged on oral diuretic, and followed at our institution. Admission, in-hospital, and pre-discharge characteristics of patients discharged with greater or less than 24-hours on oral diuretics were compared. Differences between groups on a composite 30 day all-cause mortality and all-cause rehospitalization outcome, each component, and HF rehospitalization were assessed.Of 285 patients meeting entry criteria, 178 received oral diuretics >24 hours prior to discharge and 107 were discharged < 24 hours after transitioning to oral diuretics. Baseline characteristics were similar between groups. Patients with > 24 hours observation on oral diuretics had longer in-hospital stays and greater weight and net volume loss than those observed < 24 hours. Patients receiving oral diuretics for < 24 hours were more likely to have had neurohormonal blocking agent and diuretic dose changed within 24-hours of discharge. Oral diuretic treatment for > 24 hours failed to reduce any study endpoint.Transitioning patients to oral diuretics for > 24 hours prior to discharge following HF hospitalization failed to improve 30-day outcomes. These results question this strategy for all patients hospitalized for worsening HF