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Door-to-diuretic time not linked to clinical outcomes in acute HF
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The results from a large prospective cohort study show no association between door-to diuretic time and clinical outcomes in patients with acute HF.
Data from the Korea Acute Heart Failure registry, recently published in JACC: Heart Failure, suggest that there was no difference in the in-hospital and postdischarge outcomes between patients in the early and delayed acute HF groups.
“Acute heart failure is a life-threatening condition with high morbidity and mortality, which requires immediate medical intervention,” Jin Joo Park, MD, from the division of cardiology, Cardiovascular Center, Seoul National University Bundang Hospital in Seongnam, South Korea, and colleagues wrote. “Most patients with [acute] HF present with signs and symptoms of low cardiac output. Thus, early decongestion with diuretic agents is one of the cornerstones for the treatment for patients with [acute] HF.”
To examine the effect of door-to-diuretic time on mortality in patients with acute HF who were presenting to an ED, Park and colleagues analyzed patients from the Korea Acute Heart Failure registry hospitalized for acute HF.
Patients who received IV diuretic agents within 24 hours after ED arrival were included in the study for analysis.
Early and delayed groups were defined as door-to-diuretic time 60 minutes or less and door-to-diuretic time greater than 60 minutes, respectively.
The researchers defined the primary outcomes as in-hospital death and postdischarge death at 1 month and 1 year based on door-to-diuretic time.
Of the 5,625 patients enrolled in the registry, 2,761 met the inclusion criteria defined by the researchers.
Median door-to-diuretic time was 128 minutes (interquartile range, 63-243), and 24% of patients qualified for the early group.
There was no significant difference in rates of in-hospital death (5% vs. 5.1%; P > .999), postdischarge 1-month (4% vs. 3%; log-rank P = .246) and 1-year (20.6% vs. 19.3%; log-rank P = .458) mortality rates among the early and delayed groups, respectively.
Multivariate analyses with adjustment for Get With the Guidelines-Heart Failure risk score and other significant clinical covariates and propensity-matched analyses showed that door-to-diuretic time was not associated with clinical outcomes.
In an accompanying editorial, G. Michael Felker, MD, MHS, from the Duke University School of Medicine and Duke Clinical Research Institute, and James L. Januzzi Jr., MD, from Harvard Medical School and Massachusetts General Hospital, wrote that the data available do not provide strong evidence for an important “time to treatment” effect in acute HF.
“The optimal treatment of acute heart failure remains uncertain with regard to both the importance of timing and the specific therapies likely to provide benefit,” they wrote. “Although it certainly stands to reason that prompt diagnosis and initiation of therapy are part of efficient clinical care, the overriding consideration should remain ‘get it right’ rather than ‘do it fast.’” by Dave Quaile
Disclosures: The authors, Felker and Januzzi report no relevant financial disclosures.
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