Standard diuretic therapy within GDMT yielded comparable outcomes to pleural drainage in elderly acute heart failure with moderate pleural effusion.

BackgroundPleural effusion (PE) is a common presentation in patients with congestive heart failure. Evidence on the necessity of therapeutic pleural drainage (PD) remains conflicting, highlighting a gap in optimal care for patients. This study aimed to compare standard diuretic therapy (SDT) within guideline-directed medical therapy (GDMT) versus PD in elderly acute heart failure (AHF) patients with moderate PE.Methods and resultsWe conducted a real-world multicenter, retrospective observational cohort study in China. We screened patients within the age range of 60–100 years who were admitted to hospital with AHF and moderate pleural effusions between January 2014 and January 2024. Patients were divided into two groups: the PD group and the GDMT group. The primary and secondary endpoints were time to spontaneous pleurodesis and readmission rate, respectively. Of the 936 elderly AHF patients with moderate pleural effusion who were screened, 514 of them were included in final analysis. Time to spontaneous pleurodesis and time to discharge were shorter in the GDMT group than in the PD group (P = 0.001, P = 0.001). There were no differences in 90- and 180-day readmission rates between the two groups (hazard ratio (HR) 1.450, P = 0.063 and HR 1.383,P = 0.068).ConclusionSDT within GDMT yielded comparable outcomes to pleural drainage in elderly AHF patients with moderate PE, with respect to effusion resolution and hospital length of stay, without increased risk of worsening renal function or electrolyte imbalance.