Too many heart failure patients are treated with IV fluids, study finds

Many patients hospitalized with severe heart failure are receiving potentially harmful treatment with intravenous fluids, a Yale-led study has found.

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

Heart failure patients are commonly treated with diuretics to avoid excess fluid buildup and to improve symptoms. However, many hospitalized patients also often receive IV fluids during early care in hospitals. Because the administration of IV fluids may worsen the congestive symptoms, Yale researchers decided to investigate the use of IV fluids in patients with heart failure.

The researchers reviewed data from over 130,000 hospitalizations of patients with decompensated heart failure who received IV fluids during the first two days. They found 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 Dr. Behnood Bikdeli, an internal medicine resident at Yale School of Medicine and a research scholar at Yale Center for Outcomes Research and Evaluation (CORE). That percentage is significant, he noted, considering that approximately 5 million people in the United States have a diagnosis of heart failure.

Patients given both therapies, the study found, were more likely to suffer adverse consequences, such as higher rates of critical care admission, intubation, dialysis, and even death, compared to those given diuretics alone. While the study did not determine that the IV fluids caused the negative outcomes, the link warrants further investigation, Bikdeli noted. “It’s counterintuitive. Although we have several potential explanations in mind, use of fluids may have led to worse outcomes,” he said. The retrospective review also found widespread differences in the type and amount of IV fluids given to hospitalized heart failure patients.

“Our findings are surprising and provocative,” Bikdeli said. “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.”

Other study authors include Kelly M. Strait, Dr. Kumar Dharmarajan, Shu-Xia Li, Purav Mody, Dr. Chohreh Partovian, Steven G. Coca, Dr. Nancy Kim, Dr. Leora I. Horwitz, Dr. Jeffrey M. Testani, and Dr. Harlan M. Krumholz.

This study was supported by grant DF10-301 from the Patrick and Catherine Weldon Donaghue Medical Research Foundation in West Hartford, Connecticut and by grant UL1 RR024139-06S1 from the National Center for Advancing Translational Sciences in Bethesda, Maryland. This study was also funded, in part, by grant U01 HL105270-05 (Center for Cardiovascular Outcomes  Research at Yale University) from the National Heart, Lung, and Blood Institute in Bethesda, Maryland.

(Illustration by Michael S. Helfenbein. Photo via Shutterstock)