{
  "abstract": "Background Heart failure (HF) is the leading cause of hospitalisation in patients over 65 in the UK. Most patients have severe venous congestion requiring treatment with intravenous diuretics (IV). The progress of diuresis is often measured by weight loss based on daily body weight measurements, and/or fluid balance measured on an hourly basis. However, in ward environments, the same set of scales may not always be available and the variation in measurements between scales is uncertain. Additionally, less frequent measurements of fluid balance would reduce the burden on nursing staff and may be just as accurate as hourly measurements. We designed two audits to address both uncertainties.Aim Audit 1 - to assess intra- and inter-scale variability in weight measurements in patients hospitalised with HF receiving treatment with IV diuretics; Audit 2 – to assess the accuracy of 4-hourly fluid balance measurements versus hourly measurements.Methods Audit 1 - 12 patients were assessed over 3 consecutive days ( table 1). Patients were weighed twice on two sets of scales (scales A and B) at the same time each day. We calculated mean intra-scales (A1 vs. A2), and inter-scales (A vs B) variation on each day, and the differences in weight loss after 3 days.Audit 2 – 43 patients assessed between the hours of 0900 to 1700 (table 1). Fluid intake and urine output was measured every hour by clinical staff (standard of care) and every 4 hours by investigators. Hourly net fluid loss was calculated by fluid intake – urine output / 8 hours.Results Audit 1 – The mean intra- and inter- scales difference on the same day was 0.030 kg (standard deviation (SD) ± 0.084) and 0.170 kg (± 0.245), respectively. The mean intra- and inter- scales difference in weight loss from day 1 to 3 was 0.050 kg (± 0.108) and 0.465 kg (± 0.289) respectively. Audit 2 – There was no difference in the median (1 st – 3rd interquartile range (IQR)) net fluid loss calculated on an hourly basis compared to a 4-hourly basis (208 (119 – 540) mL vs. 230 (35 – 523) mL; P=0.65) (table 2).Conclusion Our data demonstrates that the same scales must be used for accurate measurement of body weight: the mean inter-scales variation in weight loss over 3 days is similar to the difference in weight loss reported with hydrochlorothiazide plus loop diuretic compared to loop diuretic alone in the CLOROTIC trial. We also found that 4-hourly measurements of fluid balance are just accurate as hourly measurements. Fluid balance could become part of routine 4-hourly bedside observations in patients hospitalised with heart failure, which will save time for clinical staff and may enable electronic alerts for patients who not reach fluid loss targets.Abstract 5-013 Table 1 Audit 1 N=12 Audit 2 N = 43 Age 79 (68 – 86) 72 (61 – 80) Sex (male) – N (%) 9 (75) 28 (65) NTproBNP – ng/L 9318 (2124 – 29953) 8600 (2645 – 13931) Daily furosemide dose – mg 240 (80 – 330) 240 (160 – 360) Abstract 5-013 Table 2 1-hourly 4-hourly P Urine output - mL 576 (404 - 1016) 738 (429 - 1082) 0.47 Fluid intake – mL 440 (300 - 600) 465(300 - 598) 0.52 Net fluid loss - mL 208 (119 - 540) 230 (135 - 523) 0.65",
  "authors": [
    {
      "affiliations": [
        "Hull York Medical School, UK"
      ],
      "name": "Olivia Holtham"
    },
    {
      "affiliations": [
        "Hull York Medical School, UK"
      ],
      "name": "Alicia Pearson"
    },
    {
      "affiliations": [
        "Hull University Teaching Hospitals NHS Trust, Hull, UK"
      ],
      "name": "Natalia Turek"
    },
    {
      "affiliations": [
        "Hull University Teaching Hospitals NHS Trust, Hull, UK"
      ],
      "name": "Gabriela Vama"
    },
    {
      "affiliations": [
        "Hull University Teaching Hospitals NHS Trust, Hull, UK"
      ],
      "name": "Shady Hanna"
    },
    {
      "affiliations": [
        "Hull York Medical School, UK"
      ],
      "name": "Elena Beams"
    },
    {
      "affiliations": [
        "Hull York Medical School, UK"
      ],
      "name": "Joe Cuthbert"
    }
  ],
  "title": "5-013 Tracking the progress of diuresis in patients hospitalized with heart failure: body weight and hourly fluid balance. Are we doing it right?",
  "uid": "c9b06e74-709f-5e21-9bc2-09fdc7421fcd"
}