Can Door-to-Diuretic time impact mortality in Acute HF ?

In a total of 2,761 patients met the inclusion criteria and were enrolled. The median D2D time was 128 minutes (interquartile range, 63-243 minutes), and 663 (24%) patients belonged to the early group. The baseline characteristics were similar between the groups. The rate of in-hospital death did not differ between the groups (5.0% vs. 5.1%; p > 0.999), nor did the postdischarge 1-month (4.0% vs. 3.0%; log-rank p = 0.246) and 1-year (20.6% vs. 19.3%; log-rank p = 0.458) mortality rates. The Get With the Guidelines-Heart Failure risk score was calculated for each patient. In multivariate analyses with adjustment for Get With the Guidelines-Heart Failure risk score and other significant clinical covariates and propensity-matched analyses, D2D time was not associated with clinical outcomes.

The authors, therefore, concluded that D2D time was not associated with clinical outcomes in a large prospective cohort of patients with AHF who were presenting to an ED.This study reports that there was no difference in the in-hospital and post-discharge outcomes between AHF patients in the early and delayed diuretic groups. In the wake of contradictory findings in a previous study, the definitive effects of earlier diuretic therapy on outcomes need to be investigated in prospective randomized clinical studies.