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Study Questions Practice of Giving IV Fluids to Heart Failure Patients

NEW HAVEN, CT – More than one in 10 patients with severe heart failure were given intravenous fluids in combination to diuretics during their first two days of hospitalization, according to a new study that linked the practice with adverse outcomes.

The observational study, published in the Journal of the American College of Cardiology: Heart Failure, says it is the first to examine use of common IV fluids in hospitalized heart failure patients.

Diuretics are commonly used in heart failure to avoid excess fluid buildup and to improve symptoms. Noting that many inpatients also receive IV fluids during early care in hospitals, Yale University researchers sought to determine the effect of the practice.

The study involved data from more than 130,000 hospitalizations of patients with decompensated heart failure who received IV fluids during the first two days. Results indicate that 11% of the patients were treated with IV fluids in addition to diuretics.

"It was given to over 10% of heart failure patients, which to us is a big number," said first author Behnood Bikdeli, MD, internal medicine resident at Yale School of Medicine and a research scholar at Yale Center for Outcomes Research and Evaluation. The percentage represents a lot of patients, Bikdeli points out, because about 5 million people in the United States have a diagnosis of heart failure.

After receiving both therapies, patients were more likely to suffer adverse consequences, such as higher rates of critical care admission (5.7% vs. 3.8%), intubation (1.4% vs. 1.0%), renal replacement therapy (0.6% vs. 0.3%), and hospital death (3.3% vs. 1.8%) compared with those who received only diuretics.

The study was unable to clearly link the negative outcomes to the use of IV fluids but suggests that further investigation is warranted.

"It's counterintuitive. Although we have several potential explanations in mind, use of fluids may have led to worse outcomes," Bikdeli said.

The retrospective review also found widespread differences in the type and amount of IV fluids given to hospitalized heart failure patients. The median volume of administered fluid was 1,000 ml, and the most commonly used fluids were normal saline (80%) and half-normal saline (12%).

"Our findings are surprising and provocative," Bikdeli added. "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. In the interim, it would be helpful for hospital administrators to promote policies that help reduce inadvertent use of intravenous fluids for patients with heart failure."