Hemoconcentration-guided Diuresis in Heart Failure - 05/12/14
, Stephen J. Greene, MD b, Gregg C. Fonarow, MD c, Adriaan A. Voors, MD, PhD d, Javed Butler, MD, MPH e, Mihai Gheorghiade, MD bAbstract |
One quarter of patients hospitalized for heart failure are readmitted within 30 days, perhaps related to ineffective decongestion. Limited data exist guiding the extent and duration of diuresis in patients hospitalized for heart failure. The objective of this review was to determine the prognostic value of hemoconcentration, or the relative increase in the cellular elements in blood, in patients hospitalized for heart failure and to clarify its role in guiding inpatient diuretic practices. Six post hoc retrospective studies from 2010 to 2013 were available for review. Hemoconcentration was consistently associated with markers of aggressive fluid removal, including higher diuretic dosing and reduced body weight, but increased risk of in-hospital worsening renal function. Despite this, hemoconcentration was associated with improved short-term mortality and rehospitalization. Hemoconcentration is a practical, readily available, noninvasive, economically feasible strategy to help guide diuresis and monitor congestion relief in patients hospitalized for worsening heart failure. Clinicians should strongly consider using changes in hemoglobin and hematocrit as an adjunct to other available measures of decongestion and clinical acumen in inpatient heart failure care.
Le texte complet de cet article est disponible en PDF.Keywords : Diuresis, Heart Failure, Readmission
Plan
| Funding: None. |
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| Conflict of Interest: MV and SJG: None. GCF receives research support from the Agency for Healthcare Research and Quality (significant) and is a consultant to Medtronic (modest), Gambro (significant), and Novartis (significant). AAV receives consultancy fees and research grants from Alere, AstraZeneca, Bayer, Boehringer Ingelheim, Cardio3 Biosciences, Celladon, Johnson & Johnson, Merck/MSD, Novartis, Servier, Torrent, Trevena, and Vifor. JB receives research support from the National Institutes of Health, European Union, Health Resources and Services Administration, and U.S. Food and Drug Administration; is a consultant to Amgen, Bayer, Celladon, Gambro, GE Healthcare, Janssen, Medtronic, Novartis, Ono, Relypsa, and Trevena; and has stock options in Stemedica. MG is a consultant to Abbott Laboratories, Astellas, AstraZeneca, Bayer HealthCare AG, CorThera, Cytokinetics, DebioPharm S.A., Errekappa Terapeutici, GlaxoSmithKline, Ikaria, Johnson & Johnson, Medtronic, Merck, Novartis Pharma AG, Otsuka Pharmaceuticals, Palatin Technologies, Pericor Therapeutics, Protein Design Laboratories, Sanofi-Aventis, Sigma Tau, Solvay Pharmaceuticals, Takeda Pharmaceutical, and Trevena Therapeutics. |
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| Authorship: All authors had access to the data and played a role in writing this manuscript. |
Vol 127 - N° 12
P. 1154-1159 - décembre 2014 Retour au numéro
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