Door-to-Furosemide time effects on in-hospital mortality and length of stay in acute heart failure patients

Abstract Background Acute heart failure (AHF) is a common cause of hospitalization and mortality. Time-to-therapy concept may help improve in-hospital outcomes. Objective To evaluate In-hospital outcomes after receiving early versus delayed furosemide injection among AHF patients. Method Retrospective single-center cohort study included patients who were admitted with AHF through ED during 1 July 2017 to 31 Dec 2019. Door-to-furosemide (D2F) time was defined as the time from patient arrival at the ED to the first intravenous furosemide injection within 24 hours. Patients with a D2F time ≤60 min were classified as the early treatment group. Primary outcome was in-hospital mortality and secondary outcomes were in-hospital morbidities. Adjusted odd ratio and the 95% confidence interval (CI) were represented using multiple logistic regression adjusted for age, sex, weight, furosemide dose, and baseline serum creatinine. Results Among 820 enrolled AHF patients, the median D2F time was 80.5 min (interquartile range: 42 to 187 min). of those 324 (39%) patients were categorized into early D2F time group. The rate of total in-hospital death was 4.9% and did not differ between groups (3.1% vs. 6%, early vs delayed D2F group; p=0.067). In multivariate analysis, early treatment is not significantly associated with lower in-hospital mortality (odd ratio: 0.57; 95% CI: 0.27–1.23; p=0.152) as well as secondary endpoints. Conclusions In this small single-center study, early treatment with furosemide was uncommon. Less than half of admitted patients were received furosemide within 1 hour. In-hospital mortality was double in delayed group but was not statistically significant. Funding Acknowledgement Type of funding sources: None.