Ultrafiltration Devices such as Aquadex May Help Address LOS in Congestive Heart Failure Patients

In Fluid Imbalance

By: James Pitt  Aug. 28, 2018

Congestive heart failure (CHF) occurs when fluid builds up around the heart and interferes with its normal activity. An extremely common diagnosis, CHF affects about 5.7 million people, and is generally treated with diuretics.

For patients who do not respond well to diuretics, ultrafiltration is an “extremely appealing strategy” in the words of Milazzo et. al, but poorly understood. The largest planned trial, AVOID-HF, was terminated early due to only recruiting 27% of the 810 planned participants - despite encouraging early results. Median time to first heart failure event after discharge was nearly twice as long in the ultrafiltration group (62 days) as in the diuretics patients (34 days). A cost-effectiveness analysis by Constanzo et. al from Stony Brook University concluded that ultrafiltration led to 90-day cost savings over diuretics, due to improvements in duration and readmission rates.

To examine the impact of fluid imbalance on heart failure patients in Georgia, Dexur analysts examined 2013-2016 CMS inpatient claims data. The sample included patients with heart failure and shock with major complications or comorbidities (DRG 291) at 21 Georgia hospitals. At 20, patients with fluid imbalance averaged longer length of stay than patients without fluid imbalance.

Fluid Imbalance Predicts Longer Length of Stay in Heart Failure with Major Complications Georgia Hospitals

The exception was Augusta University Medical Center (Augusta, GA), where DRG 291 patients with fluid imbalance averaged 0.08 fewer days in hospital than those without fluid imbalance. The longest LOS difference was at Grady Memorial Hospital (Atlanta, GA), where DRG 291 patients with fluid imbalance averaged 7.09 days longer in hospital than DRG 291 patients without fluid imbalance.

Hospitals where fluid imbalance has a strong effect on length of stay in heart failure patients may consider using ultrafiltration/ aquapharesis systems such as Aquadex for patients whose congestive heart failure is not well-controlled by diuretics.


  1. Total DRG Discharges
  2. Total Fluid Imbalance Discharges at DRG
  3. % of Fluid Imbalance Discharges at DRG
  4. Avg. LOS at DRG
  5. Avg. LOS without Fluid Imbalance at DRG
  6. Avg. LOS with Fluid Imbalance at DRG
  7. Avg. Difference in LOS with & without Fluid Imbalance
  8. State Avg. Difference in LOS
  9. National Avg. Difference in LOS

By DRG, with Medicare-eligible inpatient discharges with DRG 291 and DRG 292 at the following hospitals:

  1. Midtown Medical Center, COLUMBUS, GA
  2. St. Marys Hospital, ATHENS, GA
  3. St. Josephs - Candler Hospital, SAVANNAH, GA
  4. Wellstar Atlanta Medical Center, ATLANTA, GA
  5. Northside Hospital Atlanta, ATLANTA, GA
  6. Coliseum Medical Centers, MACON, GA
  7. Doctors Hospital of Augusta, AUGUSTA, GA
  8. Augusta University Medical Center, AUGUSTA, GA
  9. Floyd Medical Center, ROME, GA
  10. Grady Memorial Hospital, ATLANTA, GA
  11. Saint Joseph's Hospital, SAVANNAH, GA
  12. Redmond Regional Medical Center, ROME, GA
  13. St. Francis Hospital, COLUMBUS, GA
  14. Emory University Hospital Midtown, ATLANTA, GA
  15. Memorial University Medical Center, SAVANNAH, GA
  16. Emory St Josephs Hospital, ATLANTA, GA
  17. Piedmont Athens Regional, ATHENS, GA
  18. Medical Center Navicent Health, MACON, GA
  19. University Hospital, AUGUSTA, GA
  20. Piedmont Hospital, ATLANTA, GA
  21. Emory University Hospital, ATLANTA, GA


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James Pitt

James Pitt is a science writer with experience in medical devices and textbook publishing. His hobbies include reading, flintknapping, and squinting at RStudio. He received a bachelor's in Human Evolutionary Biology from Harvard.