The Effect of Door-to-Diuretic Time on Clinical Outcomes in Patients With Acute Heart Failure

Jin Joo Park, Sun Hwa Kim, Il Young Oh, Dong Ju Choi, Hyun Ah Park, Hyun Jai Cho, Hae Young Lee, Jae Yeong Cho, Kye Hun Kim, Jung Woo Son, Byung Su Yoo, Jaewon Oh, Seok Min Kang, Sang Hong Baek, Ga Yeon Lee, Jin Oh Choi, Eun Seok Jeon, Sang Eun Lee, Jae Joong Kim, Ju Hee LeeMyeong Chan Cho, Se Yong Jang, Shung Chull Chae, Byung Hee Oh

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22 Citations (Scopus)


Objectives: This study sought to examine the impact of door-to-diuretic (D2D) time on mortality in patients with acute heart failure (AHF) who were presenting to an emergency department (ED). Background: Most patients with AHF present with congestion. Early decongestion with diuretic agents could improve their clinical outcomes. Methods: The Korea Acute Heart Failure registry enrolled 5,625 consecutive patients hospitalized for AHF. For this analysis, the study included patients who received intravenous diuretic agents within 24 h after ED arrival. Early and delayed groups were defined as D2D time ≤60 min and D2D time >60 min, respectively. The primary outcomes were in-hospital death and post-discharge death at 1 month and 1 year on the basis of D2D time. Results: A total of 2,761 patients met the inclusion criteria. The median D2D time was 128 min (interquartile range: 63 to 243 min), 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 post-discharge 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. 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. Conclusions: The D2D time was not associated with clinical outcomes in a large prospective cohort of patients with AHF who were presenting to an ED.

Original languageEnglish
Pages (from-to)286-294
Number of pages9
JournalJACC: Heart Failure
Issue number4
Publication statusPublished - 2018 Apr

Bibliographical note

Funding Information:
This work was supported by Research of Korea Centers for Disease Control and Prevention (grant nos. 2010-E63003-00, 2011-E63002-00, 2012-E63005-00, 2013-E63003-00, 2013-E63003-01, 2013-E63003-02, and 2016-ER6303-00) and by the SNUBH Research Fund (grant nos. 14-2015-029, 16-2017-003). All authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publisher Copyright:
© 2018 The Authors

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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