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Readmission rate after ultrafiltration in acute decompensated heart failure: a systematic review and meta-analysis

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Abstract

Significance of ultrafiltration in acute decompensated heart failure remains unclear. We performed meta-analysis to determine its role in reducing readmissions after acute decompensated heart failure. MEDLINE was searched using PUBMED from inception to March 22, 2017 for prospective randomized control trials comparing ultrafiltration to diuretics in acute decompensated heart failure. Five hundred ninety studies were found; nine studies with 820 patients were included. Studies with renal replacement therapy bar ultrafiltration, chronic decompensated heart failure, and non-English language were excluded. RevMan Version 5.3 was used for analysis. The primary outcomes analyzed were cumulative and 90 days readmissions secondary to heart failure and all-cause readmissions. Baseline characteristics were similar. One hundred eighty-eight patients were readmitted with heart failure, 77 vs 111 favoring ultrafiltration; risk ratio (RR) = 0.71 (95% confidence interval (CI), 0.49–1.02, p = 0.07, I 2 = 47%). Ninety days readmissions were 43 vs 67 favoring ultrafiltration; RR = 0.65 (95%CI, 0.47–0.90, p = 0.01, I 2 = 0%). Ultrafiltration showed significantly higher fluid removal and weight loss. Hypotension was common in ultrafiltration (24 vs 13, OR = 2.06, 95%CI = 0.98–4.32, p = 0.06, I 2 = 0%). Ultrafiltration showed reduced 90 days heart failure readmissions and trend towards reduced cumulative hospital readmissions. Renal and cardiovascular outcomes and hospital stay were similar.

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Acknowledgements

We acknowledge all the help and guidance that were provided by the faculty members who are involved in the creation of this manuscript. There was no funding or grant received for this analysis.

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  1. Department of Medicine, Division of Nephrology and Hypertension, Drexel University College of Medicine, Philadelphia, PA, 19102, USA

    Waqas Javed Siddiqui, Jesse M. Goldman, Ellie Kelepouris & Sandeep Aggarwal

  2. Department of Medicine, Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA, 19129, USA

    Andrew R. Kohut, Syed F Hasni, Benjamin Silverman & Howard J Eisen

  3. Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA, 19102, USA

    Waqas Javed Siddiqui, Andrew R. Kohut, Syed F Hasni, Jesse M. Goldman, Benjamin Silverman, Ellie Kelepouris, Howard J Eisen & Sandeep Aggarwal

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Siddiqui, W.J., Kohut, A.R., Hasni, S.F. et al. Readmission rate after ultrafiltration in acute decompensated heart failure: a systematic review and meta-analysis. Heart Fail Rev 22, 685–698 (2017). https://doi.org/10.1007/s10741-017-9650-3

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