Pleural effusion ups mortality, readmission risks in older adults with acute HF

The presence of pleural effusion among older patients hospitalized for acute heart failure (HF) appears to increase the risk of death and/or readmission, suggests a study.

“The use of loop diuretic therapy at discharge appeared to attenuate this risk, supporting a potential role of individualized, congestion-guided treatment strategies in this population,” said the researchers, who assessed a total of 656 older patients (median age 87 years, 65.5 percent women, 80.3 percent had HF with preserved ejection fraction) in this retrospective study.

Participants were stratified by the presence or absence of pleural effusion at admission. The composite of all-cause mortality and/or HF readmission served as the primary endpoint. The research team conducted multivariable Cox regression and interaction analyses between pleural effusion and loop diuretic use at discharge.

Of the patients, 40.5 percent had pleural effusion at admission. A significant interaction was seen between pleural effusion and loop diuretic use for the combined endpoint (p=0.043) following multivariable adjustment.

Among patients with pleural effusion, the absence of loop diuretic prescription at discharge resulted in a higher risk of death and/or rehospitalization (HR, 2.47, 95 percent confidence interval [CI], 1.28–4.77; p=0.007). On the other hand, among those discharged on loop diuretic, pleural effusion did not significantly contribute to mortality and/or hospitalization (HR, 1.21, 95 percent CI, 0.96–1.52; p=0.101).