Evaluating the Feasibility of Outpatient IV Diuretic Therapy for Patients with Decompensated Heart Failure

Heart failure is a prevalent chronic disease that contributes to many hospitalizations that may not always be necessary. Evidence supports that patients who present to the Emergency Department in fluid overload can be treated in the outpatient setting when only IV diuretic is warranted. Both decreases in costs and improved outcomes have been reported, yet there has been little movement toward providing outpatient diuresis versus hospitalization. The purpose of this DNP project was to evaluate the feasibility of an outpatient option for IV diuretic therapy for patients with acute decompensated heart failure experiencing symptoms of fluid overload. This descriptive study involved a retrospective chart review and took place at a large academic medical center. The objectives were to describe a random sample of patients that utilized an ED for IV diuretic therapy due to fluid overload from January 1, 2018 to December 31, 2018. Providers were interviewed and themes were identified to summarize their perspectives. Data analysis was performed using descriptive and correlational statistics. Significant differences were found between the LOS groups and post-ED cardiology follow-up rates (χ2(1) = 4.059, p=0.044), LOS groups and number of comorbidities (t(8)=-3.628, p=0.000), and number of ED visits and missed follow-up cardiology visits (U=554.5, p=0.003). Inconsistencies in documentation of instructions and medications were noted. Interview themes surrounded issues with continuity of care in this population of heart failure patients. There is a need for more synchronized transitions from the hospital to outpatient setting. Those with shorter LOS, less comorbidities, and more consistent follow-up may benefit from outpatient IV diuretic therapy. Future research should focus on best practice for more coordinated care and ways to engage patients with heart failure