Abstract 14909: Door-to-Diuretic Time and Mortality in Patients With Acute Heart Failure: A Meta-Analysis

Background: Recent studies have highlighted potential benefit with time-to-therapy of intravenous (IV) diuretics in patients with acute heart failure (AHF), although the data is conflicting. We sought to evaluate the impact of door-to-IV diuretic time on mortality in patients with AHF presenting to hospital.

Methods: Electronic databases were searched for prospectively registered (PROSPERO CRD42023394255) studies published up to February 2023 that evaluated the effect of door-to-IV diuretic time on clinical outcomes in AHF. The primary outcome was in-hospital mortality and the secondary outcome 30-day all-cause mortality. Three reviewers independently appraised the data, with summary odds ratios (OR) and 95% confidence intervals (CIs) pooled using a random-effects model.

Results: Seven observational studies comprising 29,102 patients were included. Three studies were prospective in design. Diuretics of choice were furosemide or bumetanide. Early IV diuretic administration was defined as a reference range from 30 to 105 minutes. Early IV diuresis was not associated with any difference in in-hospital mortality (OR 0.84, 95% CI 0.57-1.24) with high heterogeneity (I ² =74%). However, pooled data from 4 studies evaluating 30-day outcomes demonstrated reduced 30-day mortality (OR 0.77, 95% CI 0.64-0.93).

Conclusion: Door-to-IV diuretic time was not associated with reduced in-hospital death but was associated with significantly improved 30-day mortality. Prospective trials are warranted to evaluate the effect of early IV diuresis across heart failure phenotypes and disease severities.