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Dauw J, Charaya K, Lelonek M, Zegri-Reiriz I, Nasr S, Paredes-Paucar CP, Borbély A, Erdal F, Benkouar R, Cobo-Marcos M, Barge-Caballero G, George V, Zara C, Ross NT, Barker D, Lekhakul A, Frea S, Ghazi AM, Knappe D, Doghmi N, Klincheva M, Fialho I, Bovolo V, Findeisen H, Alhaddad IA, Galluzzo A, de la Espriella R, Tabbalat R, Miró Ò, Singh JS, Nijst P, Dupont M, Martens P, Mullens W. Protocolized Natriuresis-Guided Decongestion Improves Diuretic Response: The Multicenter ENACT-HF Study. Circ Heart Fail 2024; 17:e011105. [PMID: 38179728 DOI: 10.1161/circheartfailure.123.011105] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/25/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND The use of urinary sodium to guide diuretics in acute heart failure is recommended by experts and the most recent European Society of Cardiology guidelines. However, there are limited data to support this recommendation. The ENACT-HF study (Efficacy of a Standardized Diuretic Protocol in Acute Heart Failure) investigated the feasibility and efficacy of a standardized natriuresis-guided diuretic protocol in patients with acute heart failure and signs of volume overload. METHODS ENACT-HF was an international, multicenter, open-label, pragmatic, 2-phase study, comparing the current standard of care of each center with a standardized diuretic protocol, including urinary sodium to guide therapy. The primary end point was natriuresis after 1 day. Secondary end points included cumulative natriuresis and diuresis after 2 days of treatment, length of stay, and in-hospital mortality. All end points were adjusted for baseline differences between both treatment arms. RESULTS Four hundred one patients from 29 centers in 18 countries worldwide were included in the study. The natriuresis after 1 day was significantly higher in the protocol arm compared with the standard of care arm (282 versus 174 mmol; adjusted mean ratio, 1.64; P<0.001). After 2 days, the natriuresis remained higher in the protocol arm (538 versus 365 mmol; adjusted mean ratio, 1.52; P<0.001), with a significantly higher diuresis (5776 versus 4381 mL; adjusted mean ratio, 1.33; P<0.001). The protocol arm had a shorter length of stay (5.8 versus 7.0 days; adjusted mean ratio, 0.87; P=0.036). In-hospital mortality was low and did not significantly differ between the 2 arms (1.4% versus 2.0%; P=0.852). CONCLUSIONS A standardized natriuresis-guided diuretic protocol to guide decongestion in acute heart failure was feasible, safe, and resulted in higher natriuresis and diuresis, as well as a shorter length of stay.
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Affiliation(s)
- Jeroen Dauw
- Ziekenhuis Oost-Limburg, Department of Cardiology, Genk, Belgium (J.D., P.N., M.D., P.M.)
- UHasselt, Doctoral School for Medicine and Life Sciences, LCRC, Diepenbeek, Belgium (J.D., W.M.)
| | - Kristina Charaya
- Department of Cardiology, Sonography and Functional Diagnostics, First Moscow State Medical University, Russia (K.C.)
| | - Małgorzata Lelonek
- Department of Noninvasive Cardiology, Medical University of Lodz, Poland (M.L.)
| | - Isabel Zegri-Reiriz
- Department of Cardiology, Heart Failure and Heart Transplant Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (I.Z.-R.)
| | - Samer Nasr
- Department of Cardiology, Mount Lebanon Hospital-Balamand University Medical Center, Hazmiyeh (S.N.)
| | | | - Attila Borbély
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Hungary (A.B.)
| | - Fatih Erdal
- Department of Cardiology, Thorax Centrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands (F.E.)
| | - Riad Benkouar
- Benyoucef Benkhedda Faculty of Medicine, Mustapha Pacha Hospital, University of Algiers, Algeria (R.B.)
| | - Marta Cobo-Marcos
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA), Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (M.C.-M.)
| | - Gonzalo Barge-Caballero
- Advanced Heart Failure and Heart Transplant Unit, Department of Cardiology, Complexo Hospitalario Universitario A Coruña (CHUAC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain (G.B.-C.)
| | - Varghese George
- Pushpagiri Institute of Medical Sciences, Tiruvalla, India (V.G.)
| | | | - Noel T Ross
- Kuala Lumpur General Hospital, Malaysia (N.T.R.)
| | - Diane Barker
- University Hospitals of North Midlands, Stoke on Trent, United Kingdom (D.B.)
| | | | - Simone Frea
- Division of Cardiology, Città della Salute e della Scienza University Hospital of Torino, Turin, Italy (S.F.)
| | - Azmee M Ghazi
- National Heart Institute, Kuala Lumpur, Malaysia (A.M.G.)
| | - Dorit Knappe
- Department of Cardiology, University Heart and Vascular Center Hamburg, Germany (D.K.)
| | - Nawal Doghmi
- Department of Cardiology, CHU Ibn Sina, Mohammed V University, Rabat, Morocco (N.D.)
| | | | - Inês Fialho
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal (I.F.)
| | - Virginia Bovolo
- Department of Cardiology, Michele e Pietro Ferrero Hospital, Verduno, Italy (V.B.)
| | - Hajo Findeisen
- Department of Internal Medicine, Red Cross Hospital, Bremen, Germany (H.F.)
| | | | | | | | - Ramzi Tabbalat
- Department of Cardiology, Abdali Hospital, Amman, Jordan (R.T.)
| | - Òscar Miró
- Emergency Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Catalonia, Spain (Ò.M.)
| | - Jagdeep S Singh
- The Heart Centre, Royal Infirmary of Edinburgh, United Kingdom (J.S.S.)
| | - Petra Nijst
- Ziekenhuis Oost-Limburg, Department of Cardiology, Genk, Belgium (J.D., P.N., M.D., P.M.)
| | - Matthias Dupont
- Ziekenhuis Oost-Limburg, Department of Cardiology, Genk, Belgium (J.D., P.N., M.D., P.M.)
| | - Pieter Martens
- Ziekenhuis Oost-Limburg, Department of Cardiology, Genk, Belgium (J.D., P.N., M.D., P.M.)
| | - Wilfried Mullens
- UHasselt, Doctoral School for Medicine and Life Sciences, LCRC, Diepenbeek, Belgium (J.D., W.M.)
- UHasselt, Biomedical Research Institute, Faculty of Medicine and Life Sciences, LCRC, Diepenbeek, Belgium (W.M.)
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Fusco K, Sharma Y, Hakendorf P, Thompson C. The Impact of Weight Loss Prior to Hospital Readmission. J Clin Med 2023; 12:jcm12093074. [PMID: 37176515 PMCID: PMC10179303 DOI: 10.3390/jcm12093074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Hospital readmissions place a burden on hospitals. Reducing the readmission number and duration will help reduce the burden. Weight loss might affect readmission risk, especially the risk of an early (<30 days) readmission. This study sought to identify the predictors and the impact of weight loss prior to a delayed readmission (>30 days). Body mass index (BMI) was measured during the index admission and first readmission. Patients, after their readmission, were assessed retrospectively to identify the characteristics of those who had lost >5% weight prior to that readmission. Length of stay (LOS), time spent in the intensive care unit (ICU) and the one-year mortality of those patients who lost weight were compared to the outcomes of those who remained weight-stable using multilevel mixed-effects regression adjusting for BMI, Charlson comorbidity index (CCI), ICU hours and relative stay index (RSI). Those who were at risk of weight loss prior to readmission were identifiable based upon their age, BMI, CCI and LOS. Of 1297 patients, 671 (51.7%) remained weight-stable and 386 (29.7%) lost weight between admissions. During their readmission, those who had lost weight had a significantly higher LOS (IRR 1.17; 95% CI 1.12, 1.22: p < 0.001), RSI (IRR 2.37; 95% CI 2.27, 2.47: p < 0.001) and an increased ICU LOS (IRR 2.80; 95% CI 2.65, 2.96: p < 0.001). This study indicates that weight loss prior to a delayed readmission is predictable and leads to worse outcomes during that readmission.
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Affiliation(s)
- Kellie Fusco
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Yogesh Sharma
- Department of General Medicine, Division of Medicine, Cardiac & Critical Care, Flinders Medical Centre, Bedford Park, SA 5042, Australia
| | - Paul Hakendorf
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5001, Australia
| | - Campbell Thompson
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
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