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Curso de Atualização em Medicina Cardiovascular 2019
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A. Basics
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01. History of Cardiology
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05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
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26. Cardiovascular Surgery
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28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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Decongestion theraphy – Does it differ from discharge to usual life conditions and among Heart Failure patients?
Session:
Posters 1 - Écran 9 - Insuficiência Cardíaca
Speaker:
Francisco Adragão
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Francisco Pulido Adragão; Inês Lopes da Costa; Inês Nabais; Inês Egidio de Sousa; Patrícia Moniz; Luis Campos; Inês Araújo; Cândida Fonseca
Abstract
<p><strong>Introduction: </strong>Most decompensations of heart failure (HF) are due to congestion. At discharge from hospitalization patients are supposed to be in their dry weight, as congestive signs at this time are a predictor of rehospitalizations and mortality. Although most times euvolemic state is obtained during hospitalization, ambulatory habits and lifestyle diverge from hospital conditions, and medication might need to be adjusted.</p> <p><strong>Objective: </strong>To evaluate the adequacy of the prescribed diuretic dose at discharge on ambulatory conditions at reassessment after 2 weeks (average), and if there are differences on the diuretic dose among ejection fraction groups.</p> <p><strong>Methods: </strong>Retrospective study of consecutive hospitalizations due to decompensated HF in an Acute Heart Failure Unit (AHFU) over one year , between November 2017 and October 2018, examining hospital databases. Patients who were reassessed in a period of 30 days in Day Hospital (DH) were selected, and diuretic therapy changes were assessed.</p> <p><strong>Results: </strong>Of 162 patients discharged directly from the AHFU, 142 (87,7%) were referred to DH revaluation; of these, 29 didn’t attend to the booked appointment, with a final population of 113 patients. The mean time to reassessment was 12 days, with 37 (32,7%) patients needing to increase diuretic dose at this time due to congestion (average of 3,6 kg weight increase) – 81,0% needed to increase loop diuretic dose, 45,9% thiazidic-like and 8,1% mineralocorticoid receptor antagonists (MRA). 70,2% of them were with sequential nephron blockage. 51,4% patients needed endovenous diuretic administration in the first evaluation and 3 were rehospitalized before 30 days after discharge due to decompensated HF. Out of 76 patients that didn’t need diuretic adjustment in their visit, only 2 were readmitted in 30 days due to decompensated HF. 31% of non-reduced ejection fraction (non-HFrEF) needed diuretic adjustment and 34,5% of reduced ejection fraction (HFrEF)needed it as well (vide table).</p> <p><strong>Conclusion: </strong>Nearly a third of patients revaluated at DH needed diuretic adjustment at the first visit, with no difference between HFrEFand non-HFrEF. This supports the importance of early revaluation after discharge for therapy readjustment, preventing future readmissions. In our experience, revaluation at 12 days allowed not only adjustment of oral diuretic dose but also administration of IV diuretic, preventing 84,2% rehospitalizations. Diuretic doses at discharge might be appropriate for in-hospital setting, but commonly not enough at ambulatory environment. Future studies should be directed to the increase of diuretic dosage at discharge in order to prevent early readmissions and mortality. </p>
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