Effect of targeted fluid minimization and diuretic therapy on hospital- acquired heart failure and adverse outcomes in patients with no preexisting cardiac dysfunction

Background: This study aimed to investigate: 1) the incidence of hospital-acquired heart failure (HF) in patients with no preexisting cardiac disorder, and 2) whether the use of an intervention protocol comprised of targeted fluid minimization and diuretic therapy can reduce the incidence of hospital-acquired HF and adverse outcomes. Methods: We conducted a single-center, open-labeled, prospective cohort study enrolling patients with no preexisting cardiac dysfunction who were admitted to the medical wards and had a positive intravenous fluid balance > 4 L within 3 days. We assigned patients in a 1:1 ratio to the intervention protocol (intervention group) or usual care. The primary outcome was hospital-acquired HF. The secondary outcomes included in-hospital mortality, intensive critical unit (ICU) admission, mechanical ventilator usage, or prolonged hospital stay > 30 days. Results: A total of 98 patients (mean age 66; 52% male) were enrolled (intervention group, 49; usual care group, 49). The incidence of hospital-acquired HF among all patients was 21%. Patients with hospital-acquired had higher rates of in-hospital mortality (48% vs.13%; p = 0.001), ICU admission (33% vs.10%; p = 0.010) and mechanical ventilator usage (62% vs. 35%; p = 0.027). Prolonged hospital stay > 30 days rates were similar in patients with and without hospital-acquired HF. Hospital-acquired HF was not found statistically different between groups (intervention group 18% vs. usual care group 25%; p = 0.460). Patients in the intervention group did have lower rates of subsequent ICU admission (8%vs.23%; p = 0.049) and hospitalizattion > 30 days. (8%vs.27%; p = 0.018) compared with the usual care group. In-hospital mortality and mechanical ventilator usage were not different between groups. Conclusions: The incidence of hospital-acquired HF in patients with no preexisting cardiac dysfunction who had a positive cumulative fluid balance of > 4 L within 3 days was not uncommon, about one in five patients. Hospital-acquired HF can lead to increased in-hospital mortality and co-morbidities. Targeted fluid minimization and diuretics did show a reduced rate of ICU admission and prolonged hospitalization. However, no statistical difference in rates of hospital-acquired HF and in-hospital mortality compared to the control group were found.