#2865 EARLY REPEAT HOSPITALIZATION FOR FLUID OVERLOAD IN INDIVIDUALS WITH CARDIOVASCULAR RISKS
Authors: Lim Cynthia , Kadir Hanis Abdul , Huang Dorothy , Huang Zhihua , Ng Li Choo , Tan Ngiap Chuan , Tay Wei Yi , Tan Chieh Suai 
Published: June 2023

Abstract

Background and Aims
Fluid overload is a common manifestation of cardiovascular and kidney disease and a leading cause for hospitalizations. To identify patients at-risk of recurrent severe fluid overload who can benefit from strategies to reduce hospitalizations, we evaluated the incidence and risk factors associated with early repeat hospitalization for fluid overload among individuals with cardiovascular risks.

Method
Single-center retrospective cohort study of consecutive adults with an index hospitalization for fluid overload between January 2015 and December 2017 and had cardiovascular risks (older age, diabetes mellitus, hypertension, dyslipidemia, kidney disease) and/or cardiovascular disease, but excluded if lost to follow up or eGFR &lt;15 ml/min/1.73 m2. Comorbidities, biochemistry and medications were retrieved from electronic medical records. The primary outcome was early repeat hospitalization for fluid overload within 30 days of discharge. Binary logistic regression (enter method) was used to assess factors associated with repeat hospitalizations in the literature or had p≤0.25 on univariate analysis. Discrimination and calibration of the model were assessed by the area (AUC) under a receiver operating characteristic (ROC) curve and Hosmer-Lemeshow goodness-of-fit test, respectively.

Results
Among 3423 unique patients with index hospitalization for fluid overload, the mean age was 73.9 ± 11.6 years and 16.7% required high-dose intravenous (IV) furosemide. The median length of stay (LOS) was 4 (2, 9) days and 95.3% were prescribed loop diuretics at discharge. Early repeat hospitalization for fluid overload occurred in 291 patients (8.5%). After adjusting for demographic factors (age, gender, ethnicity), comorbidities (recent hospitalization, cardiovascular disease, atrial fibrillation, diabetes), medications before index hospitalization (diuretic, RAS blocker, NSAID), clinical parameters during index hospitalization (systolic BP, eGFR, IV furosemide use, LOS) and medications at discharge (diuretic, RAS blocker, statin), cardiovascular disease (adjusted OR 1.66, 95% CI 1.26-2.17, p&lt;0.001), prior hospitalization for fluid overload within 3 months before index hospitalization (adjusted OR 2.52, 95% CI 1.17-5.44, p = 0.02), prior hospitalization for any cause in within 6 months before index hospitalization (adjusted OR 1.33, 95% CI 1.02-1.73, p = 0.04) and IV furosemide during the index hospitalization (adjusted OR 1.58, 95% CI 1.10-2.28, p = 0.01) were associated with increased early repeat hospitalization for fluid overload. Higher systolic BP on admission (adjusted OR 0.992, 95% 0.986-0.998, p = 0.01) and diuretic at discharge (adjusted OR 0.50, 95% CI 0.26-0.98, p = 0.04) reduced early hospitalization for fluid overload. The model accuracy was 91.5% and the Hosmer and Lemmeshow Test chi-square p was 0.25. The AUC of the ROC curve was 0.639 (95% CI 0.606 – 0.671).

Conclusion
Patients with cardiovascular disease, prior hospitalization for fluid overload within 3 months or prior hospitalization for any cause in within 6 months before index hospitalization, lower systolic BP, need for IV furosemide during the index hospitalization and lack of diuretic at discharge were associated with increased early repeat hospitalization for fluid overload.