The Diuresis Clinic: A New Paradigm for the Treatment of Mild Decompensated Heart Failure

Background: Heart failure results in approximately 1 million hospital admissions annually in the United States and is the leading cause of 30-day readmissions. Methods: This study explores the impact of a diuresis clinic on heart failure outcomes and cost. Data were collected prospectively on all consecutive patients who received intravenous diuretics and multidisciplinary care in the clinic from its establishment from October 2011 to December 2012, as well as a comparison cohort of patients with heart failure who were admitted to the hospital for <48 hours. The percentage of hospitalized days was calculated for both cohorts 180 days before and 180 days after each patient's index visit. Results: In the diuresis clinic group, 106 patients (mean age, 68.2 ± 13 years; 48% were women) were treated over 328 visits (1-22 visits per person), with a mean intravenous furosemide dose of 100 mg, average urine output of 1460 ± 730 mL, and weight loss of 2.3 ± 1.8 kg. Days hospitalized decreased from 38.3 to 31.2 per 1000 patient-days after the index diuresis clinic visit (P <.01). In the comparison group, 143 patients (mean age, 69 ± 16 years; 54% were women) were admitted for <48 hours. Days hospitalized increased from 14.4 to 21.0 per 1000 patient-days after index admission (P <.01). On multivariate analysis, the diuresis clinic was associated with 3 fewer days in the hospital per 180 days per patient, with an estimated annual savings of $12,113 per patient. Conclusions: Compared with a brief hospital stay, treatment of mild decompensated heart failure in a diuresis clinic resulted in a substantial and cost-effective decline in the rate of subsequent hospitalization.