Effect of Post-Loop Diuretic Urinary Sodium Level on Length of Stay and Rehospitalization in Acutely Decompensated Heart Failure Patients

Rarsari Soerarso; Dian Yaniarti Hasanah; Emir Yonas; Fikri Muhamad Yamin Tawari; Sunu Budhi Raharjo; Bambang Budi Siswanto; Maarten J Cramer; Pim van der Harst; Marish I F J Oerlemans

doi:10.14740/cr1696

Effect of Post-Loop Diuretic Urinary Sodium Level on Length of Stay and Rehospitalization in Acutely Decompensated Heart Failure Patients

Cardiol Res. 2024 Oct;15(5):350-357. doi: 10.14740/cr1696. Epub 2024 Sep 16.

Authors

Rarsari Soerarso¹, Dian Yaniarti Hasanah¹, Emir Yonas¹, Fikri Muhamad Yamin Tawari¹, Sunu Budhi Raharjo¹, Bambang Budi Siswanto¹, Maarten J Cramer², Pim van der Harst², Marish I F J Oerlemans²

Affiliations

¹ Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
² Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan, The Netherlands.

Abstract

Background: In Indonesia, heart failure has become a major community problem because of the high cost of care, low quality of life, and premature death. Until now, loop diuretics are still the main therapy in patients with acute decompensated heart failure with clinical congestion. Diuretic responsiveness can be assessed objectively by measuring sodium urine. This study aimed to determine the response of natriuresis 2 h after loop diuretic administration and its relationship to length of stay and readmission within 30 days in daily clinical practice.

Methods: This is a prospective cohort study conducted at the National Cardiovascular Center Harapan Kita Hospital in acute decompensated heart failure patients. Patient characteristics were collected from medical records. Response to intravenous (IV) loop diuretics was assessed using urinary sodium laboratory panels. The primary outcomes of interest in this study were length of stay and rehospitalization. Analyses were conducted between the outcome of interests and patient characteristics.

Results: There were 51 acute decompensated heart failure patients in this study with 78.4% males. The mean age was 52.47 ± 13.62. The mean ejection fraction was 37.53±17.95%, with the majority of patients having a left ventricular ejection fraction less than 40% (62.7% of study subjects). The average glomerular filtration rate of subjects in this study was 57.29 ± 27.25 mL/min. Pearson correlation test between pre- and post-loop diuretic urinary sodium showed trends of significant correlation (r = -0.238, P = 0.093) and (r = -0.308, P = 0.028), respectively. Patients with lower pre-loop diuretic urinary sodium were shown to have a shorter length of stay (8.57 ± 6.161 vs. 5.30 ± 4.01, P = 0.04), while patients with lower post-loop diuretic urinary sodium showed trends of longer length of stay (8.67 ± 4.14 vs. 6.03 ± 5.39, P = 0.126).

Conclusions: In this study, we observe lower rehospitalization in patients with higher pre-loop diuretic urinary sodium levels. Post-loop diuretic urinary sodium level was shown to be inversely related to length of stay in acute decompensated heart failure patients.

Keywords: Acute decompensated heart failure; Loop diuretic; Urine sodium.

Grants and funding

This paper received no specific grant from any funding agency, commercial or not-for-profit sectors.