Study Design Summary: Observational multicenter study of patients presenting to ED for acute heart failure. No protocol on which medications/treatment to give or timing of medications since it was observational. Primary outcome was all cause in-hospital mortality. 1,291 total patients, 481 in early treatment group, 810 in nonearly group. Early treatment was defined as lasix within 60 minutes of ED arrival, nonearly was defined as >60 minutes but less than 24 hours. Median time overall was 90 minutes. for all 1,291 patients.
Notes: The early treatment group were more likely to arrive by ambulance, onset of symptoms <6 hours prior to arrival, higher HR and BP, as well as more peripheral and pulmonary edema, JVD, orthopnea by a large margin. There was decreased in-hospital mortality in the early treatment group. This maybe was because the disease was recognized earlier and thus treated earlier. Similar to the increased mortality rate of low symptomatic brain mets.
There was also an inflection point in the mortality of the groups. If lasix was given within the first hour there was an association with decreased mortality. Patients given lasix just after 60 minutes had increased mortality which then dropped off quickly, but slowly increased back again the further out from 1 hour from admission they got. This phenomenon may point more towards a disease process driving mortality rather than the lasix since the body and the drug do not respect time in that fashion.
The early treatment group had worse symptoms but improved mortality. Similar NYHA III and IV between the two groups. More patients in non-sinus rhythm in nonearly treatment group.
Hard to attribute in-hospital mortality to lasix within the first 60 minutes of hospital presentation based on face validity. PPV and inodilators would have more face validity as patients who need these are likely on the cusp of death, but as long as ABCs/pulm edema controlled, lasix to continue the fluid management after initial fluid management is important but maybe not in-hospital mortality level important.
The study mentioned that more patients had history of HF in nonearly group but then the tables seemed to contradict that later. So unsure how to interpret that.
Study Conclusion: IV lasix given within 60 minutes of hospital arrival was independently associated with better in-hospital mortality.
Fusion Beat Bottom Line Impression: This observational study demonstrates an association between IV lasix within 60 minutes and improved in-hospital morality in AHF patients, however, given the differences in group presentations and gut feeling/face validity, it seems more of this survival benefit was potentially due to early recognition of disease. No causation of early lasix with improved mortality can be demonstrated by this study.
A Fusion Beat 