Efficacy of Home-adjusting diuretic compared with Office-adjusting diuretic in Chronic Heart Failure Patients

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 Background: Diuretic self-adjustment at home has become widely used in many countries among chronic heart failure (CHF) patients, but its use is still new to Thailand.

Objective: To compare diuretic self-adjustment at home versus office-adjusted diuretic, including number of visits to the emergency department (ED) or out patient department (OPD), hospitalization, and mortality rate.

Design: A randomized control trial was conducted at Abhaiphubejhr Hospital in Thailand. Participants were 91 CHF patients, who were assigned into either the home diuretic self-adjustment group (experimental group) or the hospital office-adjusted diuretic group (control group). All participants were monitored for six months. (control group). All participants had been follow up for six months.

Results: Among 91 patients recruited over one year, 45 patients were assigned into the experimental group and the other 46 patients into the control group. Numbers of visits to the ED or OPD were 18 among 10 patients in the experimental group compared to 11 among 10 patients in the control group, which was not a statistically significant difference (p = 0.352). There was a statistically significant difference between hospitalization rates with the experimental group having fewer – 10 hospitalizations in the control group (21.7%) compared to 4 hospitalizations in the experimental group (8.8%) (p = 0.042). No mortality events occurred in the experimental group while there were five deaths in the control group (10.9%) (p = 0.014) 

Conclusion: Among patients with CHF, the home diuretic self-adjustment group had lower mortality and hospitalization rates compared to the office-adjusted diuretic group. However, there was no statistically significant difference in the number of visits to the ED or OPD.


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นิพนธ์ต้นฉบับ (Original article)


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