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Adult nursing
Early diuretic administration may improve outcomes for patients presenting with heart failure exacerbation
  1. Sanya Bawa1,
  2. Nisha A Gilotra2
  1. 1 Johns Hopkins University, Baltimore, Maryland, USA
  2. 2 Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Nisha A Gilotra, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; naggarw2{at}

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Commentary on: Dzikowicz DJ, Pokhrel Bhattarai S, Ng J, et al. Delays in door-to-diuretic time and 1-year mortality among patients with heart failure. J Cardiovasc Nurs 2022;37:410–7.

Implications for practice and research

  • Prompt diuretic administration is essential to improving clinical outcomes for patients presenting to the emergency department with heart failure exacerbation.

  • Prospective clinical trials are needed to evaluate the impact of diuretic administration timing and patient reported and clinical outcomes.


Heart failure (HF) accounts for high hospitalisation rates and mortality.1 HF clinical practice guidelines emphasise the administration of timely intravenous diuretics, which are used to relieve congestion, the most common reason for HF hospitalisation. The time between patient presentation and administration of diuretics is known as the door-to-diuretic time. While some studies2 3 have examined the association of door-to-diuretic time with outcomes, results are heterogenous and there is still …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.