Real-World Evaluation of Individualised Natriuresis and Diuresis Driven Protocol for Decongestion in Acute Heart Failure

BACKGROUND AND AIMS: Acute decompensated heart failure (ADHF) results in high rates of hospitalisation, re-admissions, and mortality, straining healthcare systems. Loop diuretics are crucial for fluid management in ADHF, but optimal dosing and monitoring remain unclear. The 2021 European Society of Cardiology guidelines suggest individualised dosing based on home diuretic use and close urinary sodium monitoring for better decongestion. This study evaluates the effectiveness of a new natriuresis- and urine output-guided protocol at Maastricht University Medical Centre+ (MUMC+) based on these recommendations. METHODS: This retrospective study compared patients treated with a natriuresis- and urine output-guided protocol, introduced in May 2022, to those receiving standard care before May 2022. The guided protocol involved individualised loop diuretic dosing, regular urine sodium monitoring, and incremental adjustments as needed. Data on demographics, lab values, length of stay, mortality, and re-admission rates were analysed, with statistical adjustments for potential confounders. RESULTS: The guided protocol was associated with significantly shorter hospital stay (median 6.9 vs. 7.5 days, P=0.029), lower six-month mortality (10.9% vs. 17.9%, P=0.017), and cardiac rehospitalisation rates (26.1% vs. 35.7%, P=0.015). These effects were independent of baseline differences and confounders. At 12 months, the guided protocol group showed sustained association of reduced cardiac rehospitalisation rates and a trend toward lower mortality. CONCLUSION: This guided AHF protocol was associated with reduced hospital stays, six-month rehospitalisation rates, and mortality. Tailoring individual optimised diuretic therapy for ADHF seems promising, but further research is needed to confirm its long-term benefits.