Outpatient intravenous diuresis in a rural setting: safety, efficacy, and outcomes
PurposeTo evaluate the safety, efficacy, and outcomes of outpatient intravenous diuresis in a rural setting and compare it to urban outcomes.MethodsA single-center study was conducted on 60 patients (131 visits) at the Dartmouth-Hitchcock Medical Center (DHMC) from 1/2021–12/2022. Demographics, visi...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-05-01
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| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1155957/full |
| _version_ | 1797820491779538944 |
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| author | Girish Pathangey Susan P D’Anna Rohitha A. Moudgal David B. Min Katharine A. Manning Cynthia C. Taub Lauren G. Gilstrap |
| author_facet | Girish Pathangey Susan P D’Anna Rohitha A. Moudgal David B. Min Katharine A. Manning Cynthia C. Taub Lauren G. Gilstrap |
| author_sort | Girish Pathangey |
| collection | DOAJ |
| description | PurposeTo evaluate the safety, efficacy, and outcomes of outpatient intravenous diuresis in a rural setting and compare it to urban outcomes.MethodsA single-center study was conducted on 60 patients (131 visits) at the Dartmouth-Hitchcock Medical Center (DHMC) from 1/2021–12/2022. Demographics, visit data, and outcomes were collected and compared to urban outpatient IV centers, and inpatient HF hospitalizations from DHMC FY21 and national means. Descriptive statistics, T-tests and chi-squares were used.ResultsThe mean age was 70 ± 13 years, 58% were male, and 83% were NYHA III-IV. Post-diuresis, 5% had mild-moderate hypokalemia, 16% had mild worsening of renal function, and 3% had severe worsening of renal function. No hospitalizations occurred due to adverse events. The mean infusion-visit urine output was 761 ± 521 ml, and post-visit weight loss was −3.9 ± 5.0 kg. No significant differences were observed between HFpEF and HFrEF groups. 30-day readmissions were similar to urban outpatient IV centers, DHMC FY21, and the national mean (23.3% vs. 23.5% vs. 22.2% vs. 22.6%, respectively; p = 0.949). 30-day mortality was similar to urban outpatient IV centers but lower than DHMC FY21 and the national means (1.7% vs. 2.5% vs. 12.3% vs. 10.7%, respectively; p < 0.001). At 60 days, 42% of patients had ≥1 clinic revisit, 41% had ≥1 infusion revisit, 33% were readmitted to the hospital, and two deaths occurred. The clinic avoided 21 hospitalizations, resulting in estimated cost savings of $426,111.ConclusionOP IV diuresis appears safe and effective for rural HF patients, potentially decreasing mortality rates and healthcare expenses while mitigating rural-urban disparities. |
| first_indexed | 2024-03-13T09:39:05Z |
| format | Article |
| id | doaj.art-101a81f61986488298f4379285aa2e27 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-03-13T09:39:05Z |
| publishDate | 2023-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-101a81f61986488298f4379285aa2e272023-05-25T04:29:18ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-05-011010.3389/fcvm.2023.11559571155957Outpatient intravenous diuresis in a rural setting: safety, efficacy, and outcomesGirish Pathangey0Susan P D’Anna1Rohitha A. Moudgal2David B. Min3Katharine A. Manning4Cynthia C. Taub5Lauren G. Gilstrap6Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New HampshireHeart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New HampshireDepartment of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New HampshireHeart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New HampshireHeart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New HampshireHeart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New HampshireHeart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New HampshirePurposeTo evaluate the safety, efficacy, and outcomes of outpatient intravenous diuresis in a rural setting and compare it to urban outcomes.MethodsA single-center study was conducted on 60 patients (131 visits) at the Dartmouth-Hitchcock Medical Center (DHMC) from 1/2021–12/2022. Demographics, visit data, and outcomes were collected and compared to urban outpatient IV centers, and inpatient HF hospitalizations from DHMC FY21 and national means. Descriptive statistics, T-tests and chi-squares were used.ResultsThe mean age was 70 ± 13 years, 58% were male, and 83% were NYHA III-IV. Post-diuresis, 5% had mild-moderate hypokalemia, 16% had mild worsening of renal function, and 3% had severe worsening of renal function. No hospitalizations occurred due to adverse events. The mean infusion-visit urine output was 761 ± 521 ml, and post-visit weight loss was −3.9 ± 5.0 kg. No significant differences were observed between HFpEF and HFrEF groups. 30-day readmissions were similar to urban outpatient IV centers, DHMC FY21, and the national mean (23.3% vs. 23.5% vs. 22.2% vs. 22.6%, respectively; p = 0.949). 30-day mortality was similar to urban outpatient IV centers but lower than DHMC FY21 and the national means (1.7% vs. 2.5% vs. 12.3% vs. 10.7%, respectively; p < 0.001). At 60 days, 42% of patients had ≥1 clinic revisit, 41% had ≥1 infusion revisit, 33% were readmitted to the hospital, and two deaths occurred. The clinic avoided 21 hospitalizations, resulting in estimated cost savings of $426,111.ConclusionOP IV diuresis appears safe and effective for rural HF patients, potentially decreasing mortality rates and healthcare expenses while mitigating rural-urban disparities.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1155957/fullrural-urbanheart failurerural healthruralityhealth disparitiesdiuresis clinic |
| spellingShingle | Girish Pathangey Susan P D’Anna Rohitha A. Moudgal David B. Min Katharine A. Manning Cynthia C. Taub Lauren G. Gilstrap Outpatient intravenous diuresis in a rural setting: safety, efficacy, and outcomes Frontiers in Cardiovascular Medicine rural-urban heart failure rural health rurality health disparities diuresis clinic |
| title | Outpatient intravenous diuresis in a rural setting: safety, efficacy, and outcomes |
| title_full | Outpatient intravenous diuresis in a rural setting: safety, efficacy, and outcomes |
| title_fullStr | Outpatient intravenous diuresis in a rural setting: safety, efficacy, and outcomes |
| title_full_unstemmed | Outpatient intravenous diuresis in a rural setting: safety, efficacy, and outcomes |
| title_short | Outpatient intravenous diuresis in a rural setting: safety, efficacy, and outcomes |
| title_sort | outpatient intravenous diuresis in a rural setting safety efficacy and outcomes |
| topic | rural-urban heart failure rural health rurality health disparities diuresis clinic |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1155957/full |
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