Review of hospital care finds high rates of IV fluids given for acute heart failure

Early care with intravenous (IV) fluid is not recommended by guidelines for patients with acute decompensated heart failure. However, 11 percent of patients in a study published Feb. 1 in the Journal of the American College of Cardiology: Heart Failure received IV fluid and diuretics in the first two days of hospitalization.

Behnood Bikdeli, MD, from the Center for Outcomes Research and Evaluation at Yale–New Haven Hospital in New Haven, Conn., and colleagues used a nationwide database containing 346 hospitals, representative of 20 percent of acute care admissions in the U.S. for their study. While all patients received diuretics as per recommendations, they found that at use of IV fluids for severe heart failure patients varied between hospitals. Some treated upwards of 71 percent of acute decompensated heart failure patients thusly, while others did not administer fluids to patients with these symptoms.

Administering IV fluids contradicts diuretics for care of heart failure patients, Bikdeli et al wrote, since the use of diuretics is intended to improve symptoms and cardiovascular function by reducing excess fluid.

When given IV fluids, these patients had nearly doubled rates of hospital death (3.3 percent vs 1.8 percent). Subsequent critical care admissions increased significantly in these patients as well (5.7 percent vs. 1.8 percent). Rates of intubation and renal replacement therapy were also higher: 1.4 percent vs 1.0 percent and 0.6 percent vs. 0.3 percent, respectively.

“It’s counterintuitive. Although we have several potential explanations in mind, use of fluids may have led to worse outcomes,” said Bikdeli in a press release.

Bikdeli et al called for hospitals to review their procedures and improve policies to reduce inadvertent use, adding, “We need to better understand who these patients are, why they received intravenous fluids, and whether use of intravenous fluids was the cause of their worse outcomes.”