Heart failure (HF) is a leading cause of hospitalization in the United States. Decongestion remains a central goal of inpatient management, but contemporary decongestion practices and associated weight loss have not been well characterized nationally. This study aimed to describe contemporary inpatient diuretic practices and clinical predictors of weight loss in patients hospitalized for HF. The authors identified HF hospitalizations from 2015 to 2022 in a U.S. national database aggregating deidentified patient-level electronic health record data across 31 geographically diverse community-based health systems. The authors report patient characteristics and inpatient weight change as a primary indicator of decongestion. Predictors of weight loss were evaluated using multivariable models. Temporal trends in inpatient diuretic practices, including augmented diuresis strategies such as adjunctive thiazides and continuous diuretic infusions, were assessed. The study cohort included 262,673 HF admissions across 165,482 unique patients. The median inpatient weight loss was 5.3 pounds (Q1-Q3: 0.0-12.8 pounds) or 2.4 kg (Q1-Q3: 0.0-5.8 kg). Discharge weight was higher than admission weight in 20% of encounters. An increase of ≥0.3 mg/dL in serum creatinine from admission to inpatient peak occurred in >30% of hospitalizations and was associated with less weight loss. Adjunctive diuretic agents were utilized in <20% of encounters but were associated with greater weight loss. In a large-scale U.S. community-based cohort study of HF hospitalizations, estimated weight loss from inpatient decongestion remains highly variable, with weight gain observed across many admissions. Augmented diuresis strategies were infrequently used. Comparative effectiveness trials are needed to establish optimal strategies for inpatient decongestion for acute HF.

中文翻译：

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因心力衰竭住院患者的当代减充血策略：一项基于社区的全国队列研究

心力衰竭（HF）是美国住院的主要原因。缓解充血仍然是住院患者管理的核心目标，但当代缓解充血实践和相关的体重减轻尚未在全国范围内得到很好的描述。本研究旨在描述当代住院患者的利尿实践和因心力衰竭住院患者体重减轻的临床预测因素。作者在美国国家数据库中确定了 2015 年至 2022 年的心力衰竭住院情况，该数据库汇总了 31 个不同地理位置的社区卫生系统中未识别的患者级电子健康记录数据。作者报告了患者特征和住院患者体重变化作为缓解充血的主要指标。使用多变量模型评估体重减轻的预测因素。评估了住院患者利尿实践的时间趋势，包括辅助性噻嗪类药物和持续利尿剂输注等增强利尿策略。该研究队列包括 165,482 名独特患者中的 262,673 名 HF 入院患者。住院患者体重减轻中位数为 5.3 磅（Q1-Q3：0.0-12.8 磅）或 2.4 公斤（Q1-Q3：0.0-5.8 公斤）。 20% 的遭遇中，出院体重高于入场体重。从入院到住院峰值，血清肌酐增加 ≥0.3 mg/dL 的情况发生在超过 30% 的住院患者中，并且与体重减轻较少相关。辅助利尿剂的使用率<20%，但与更大的体重减轻相关。在美国一项针对心力衰竭住院治疗的大规模社区队列研究中，住院患者缓解充血后的体重减轻估计值仍然存在很大差异，许多入院患者都观察到体重增加。很少使用强化利尿策略。需要进行比较有效性试验来建立急性心力衰竭住院患者缓解充血的最佳策略。