Reducing Heart Failure Hospitalizations With Proactive Outpatient Diuretic Management: A Real-World Observational Study.

BACKGROUND: Recurrent congestion remains a major driver of heart failure (HF)-related acute care utilization despite guideline-directed medical therapy. PROJECT RATIONALE: The Congestive Heart Failure Navigator program was developed to support early recognition of worsening HF and proactive HF optimization. This study evaluated whether higher outpatient diuretic optimization intensity was associated with reduced HF hospitalizations. PROJECT SUMMARY: This retrospective quality improvement study evaluated patients enrolled in the Congestive Heart Failure Navigator program during 2025. Temporal associations between prior-month oral diuretic optimization and HF hospitalizations were analyzed using regression models. The program managed a mean of 54 patients monthly, with hospitalization rates remaining low (0-9.4 per 100 patients). Higher outpatient diuretic optimization intensity was associated with fewer subsequent HF hospitalizations (incidence rate ratio: ≈0.94; P ≈ 0.046). In a pre-post analysis (n = 38), HF hospitalizations declined from 34.2% to 18.4%. TAKE-HOME MESSAGE: Higher-intensity outpatient oral diuretic optimization may represent a scalable early congestion management strategy associated with reduced HF hospitalizations.