TY  - GEN
N2  - Heart failure, the fifth most common cause for hospitalization, is associated with the highest 30-day readmission rate among all diagnoses in the United States (Finger, Barrett, & Jiang, 2017; McDermott, Elixhauser, & Sun, 2017).  A strong incentive to reduce 30-day readmissions has come from the association between increased mortality and subsequent heart failure readmissions, as well as reimbursement penalties imposed on hospitals in cases of 30-day all-cause readmissions for heart failure patients (Gupta & Fonarow, 2018, Lin, Chin, Sicignano, & Evans, 2017).  Decongestive therapy with intravenous (IV) loop diuretics is part of the standard of care for patients hospitalized with acute-on-chronic decompensated heart failure (Yancy et al., 2013).  A large proportion of patients admitted with acute-on-chronic decompensated heart failure are inadequately decongested prior to discharge, putting them at risk for 30-day hospital readmission (Gheorghiade et al., 2006; Lala et al., 2015).  Since assessment methods for adequate decongestion have demonstrated limitations, current expert recommendations advocate for at least 24 hours of inpatient observation following the transition from IV to oral loop diuretics (Hollenberg et al., 2019).  This quality improvement project designed to elucidate the utility of this recommendation for local implementation did not find evidence to support the use of a 24-hour cutoff point for inpatient observation of patients with chronic stage C heart failure with reduced left ventricular ejection fraction (? 40 percent) hospitalized for acute-on-chronic decompensated heart failure.  This result should be interpreted with caution given the project's methodological limitations inherent to the observational design and small sample size.  
DO  - 10.6083/f1881m566
DO  - DOI
AB  - Heart failure, the fifth most common cause for hospitalization, is associated with the highest 30-day readmission rate among all diagnoses in the United States (Finger, Barrett, & Jiang, 2017; McDermott, Elixhauser, & Sun, 2017).  A strong incentive to reduce 30-day readmissions has come from the association between increased mortality and subsequent heart failure readmissions, as well as reimbursement penalties imposed on hospitals in cases of 30-day all-cause readmissions for heart failure patients (Gupta & Fonarow, 2018, Lin, Chin, Sicignano, & Evans, 2017).  Decongestive therapy with intravenous (IV) loop diuretics is part of the standard of care for patients hospitalized with acute-on-chronic decompensated heart failure (Yancy et al., 2013).  A large proportion of patients admitted with acute-on-chronic decompensated heart failure are inadequately decongested prior to discharge, putting them at risk for 30-day hospital readmission (Gheorghiade et al., 2006; Lala et al., 2015).  Since assessment methods for adequate decongestion have demonstrated limitations, current expert recommendations advocate for at least 24 hours of inpatient observation following the transition from IV to oral loop diuretics (Hollenberg et al., 2019).  This quality improvement project designed to elucidate the utility of this recommendation for local implementation did not find evidence to support the use of a 24-hour cutoff point for inpatient observation of patients with chronic stage C heart failure with reduced left ventricular ejection fraction (? 40 percent) hospitalized for acute-on-chronic decompensated heart failure.  This result should be interpreted with caution given the project's methodological limitations inherent to the observational design and small sample size.  
AD  - Oregon Health and Science University
T1  - Duration of inpatient observation after transition to oral diuretics: effect on 30-day readmissions for heart failure patients
DA  - 2020-06-01
AU  - Samuel, Nathan D.
L1  - https://digitalcollections.ohsu.edu/record/7989/files/Samuel.Nathan.2020.pdf
PB  - Oregon Health and Science University
PY  - 2020-06-01
ID  - 7989
L4  - https://digitalcollections.ohsu.edu/record/7989/files/Samuel.Nathan.2020.pdf
KW  - Diuretics
KW  - Observation
KW  - Hospitalization
KW  - Heart Failure
KW  - Inpatients
KW  - therapy
TI  - Duration of inpatient observation after transition to oral diuretics: effect on 30-day readmissions for heart failure patients
Y1  - 2020-06-01
L2  - https://digitalcollections.ohsu.edu/record/7989/files/Samuel.Nathan.2020.pdf
LK  - https://digitalcollections.ohsu.edu/record/7989/files/Samuel.Nathan.2020.pdf
UR  - https://digitalcollections.ohsu.edu/record/7989/files/Samuel.Nathan.2020.pdf
ER  -