reduced functional capacity, and these patients remained at high risk for requiring advanced therapies while patients with reduced CI but preserved exercise capacity were uncommon in our study (Figure). Conclusions: Ambulatory patients with advanced HF can have low CI without evidence of end-organ dysfunction. Low CI is independently associated with higher rates of death, transplant or LVAD. Patients with preserved resting CI but poor functional capacity, so called “cardiac insuffi- ciency”, are commonly encountered and have poor outcomes with medical management. 122 Anemia Is Associated with Adverse Clinical Outcomes in Children Hospitalized with Acute Heart Failure Jason F. Goldberg 1 , Mona D. Shah 1 , Kevin Chiou 2 , Jonathan Hanna 2 , Joseph L. Hagan 1 , Antonio G. Cabrera 1 , Aamir Jeewa 1 , Jack F. Price 1 ; 1 Baylor College of Medicine, Houston, TX; 2 Duke University, Durham, NC Introduction: Anemia is a common finding in adult patients with heart failure (HF). Low hemoglobin (Hgb) concentration is associated with adverse clinical outcomes in adults, but data are lacking in children with HF. Hypothesis: Anemic patients hospi- talized with acute HF are more likely to die, require heart transplant, or need mechan- ical circulatory support (MCS) than non-anemic patients. Methods: A retrospective chart review was performed for patients hospitalized at our institution with acute HF from 2007-2012. We required that HF be attributable to ventricular dysfunction and excluded patients admitted for acute graft rejection, those with HF due to intracardiac shunts, and patients less than 4 months of age. All potential enrollees were adjudi- cated by a pediatric HF specialist. Anemia was defined as Hgb ! 10 mg/dl. Multi- variate analysis was used to control for renal failure (defined as eGFR ! 30 ml/min per 1.73 m 2 ). Results: We identified 172 hospital admissions for acute HF in 130 pa- tients. The sample included 98 initial presentations of HF and 74 admissions after previous HF hospitalization. Patient ages ranged from 4 months to 23 years, with a median of 7.5 years. Etiologies of HF included: dilated cardiomyopathy (n 5 125), restrictive cardiomyopathy (n 5 16), ischemic cardiomyopathy (n 5 25), and heart failure after history of congenital heart disease (n 5 6). Mean Hgb concen- tration at admission was 11.8 mg/dL (6 2.0 mg/dL). Mean lowest Hgb prior to outcome was 10.8 mg/dL (6 2.2 mg/dL). Anemia was present in 24 cases (14%) at admission and in 66 cases (38%) before outcome. Anemia was associated with increased risk of death, transplant, or need for MCS (adjusted odds ratio 5 1.8, 95% confidence interval [CI] 5 1.2 - 2.9, p 5 0.011) during hospitalization. For every 1 mg/dl increase in Hgb, the odds of death, transplant, or MCS deployment decreased by 18% (adjusted odds ratio 5 0.8, 95% CI 5 0.7 - 0.9, p 5 0.002). Con- clusions: Anemia occurs commonly in children hospitalized for acute heart failure and is associated with increased incidence of transplant, mechanical circulatory sup- port, and in-hospital mortality. 123 Efficacy and Safety of an Intravenous Diuretic Dosing Protocol for the Treatment of Decompensated Heart Failure in an Ambulatory Heart Failure Clinic Leo Buckley, Danielle Carter, Lina Matta, Judy Cheng, Craig Stevens, Roman Belenkiy, Michelle Young, Cynthia Weiffenbach, Lynne Stevenson; Akshay Desai. Brigham and Women’s Hospital, Boston, MA Introduction: The available data on short courses of intravenous (IV) diuretic administration for the treatment of decompensated heart failure (HF) and prevention of hospitalization are limited. Hypothesis: In patients with decompensated HF, a standardized IV diuretic dosing protocol can be used to achieve effective and safe diuresis in the ambulatory setting. Methods: Between September 1, 2013 and February 15, 2014, patients with HF and worsening signs and symptoms of conges- tion at rest or on minimal exertion received IV furosemide at our ambulatory heart failure triage and intervention unit. Patients on home oral furosemide (or equivalent) doses of 0-40 mg, 41-160 mg, 161-300 mg and $ 301 mg were assigned to the low, standard, high and mega diuretic dose protocol groups, respectively (see figure). The efficacy outcomes were total urine output (UOP) during encounter and change in weight from the day before the encounter to the day after the encounter. The primary safety outcomes were rates of hypokalemia (potassium # 3.5 mEq/L with a decrease $ 0.5 mEq/L) and worsening of renal function (increase in serum creatinine $ 0.3 mg/dL). Results: Sixty patients with median age 70 years [IQR 58, 80] were treated during 114 separate encounters. The median home daily diuretic dose was 240 mg (IQR 80, 800) of oral furosemide or equivalent. Patients received a median IV furo- semide dose of 260 mg (IQR 140, 260) per encounter. The median total urine output and median change in weight were 1.1 liters [IQR 0.6, 1.4] and -1.1 kg [IQR -1.9, -0.2] per encounter, respectively (see table). There were no significant differences in efficacy outcomes between protocol groups with the exception of total urine output, which was greater in the low dose group compared to the mega dose group (p ! 0.05). The incidence of worsening of renal dysfunction was 9% and resolved in 9 of these 10 patients. The incidence of hypokalemia was 3%. Conclusions: The use of short courses of IV diuretic administration according to this protocol was associated with significant urine output and weight loss across a wide range of home diuretic doses. This strategy may avert the need for hospitalization in selected patients with volume overload. 124 Association of Worsening Renal Function with Length of Stay and Costs in Patients Hospitalized with Acute Heart Failure Jacqueline B. Palmer 1 , Howard S. Friedman 2 , Katherine Waltman Johnson 1 , Prakash Navaratnam 2 , Stephen S. Gottlieb 3 ; 1 Novartis Pharmaceuticals Corporation, East Hanover, NJ; 2 DataMed Solutions LLC, New York, NY; 3 University of Maryland, Baltimore, MD Background: The association between worsening renal function (WRF) and the out- comes of length of stay (LOS) and costs in patients hospitalized with acute heart fail- ure (AHF) were examined. Methods: A patient’s first AHF hospitalization event (index hospitalization) between Jan 2008 to March 2011 was identified in the Cerner Health FactsÒ database. Patients had to have $ 3 records of serum creatinine (SCr) laboratory values for the index hospitalization and a SCr lab value within 1 day of admission (baseline SCr). Patients missing cost or LOS data or who were hospitalized for elective AHF procedures, underwent cardiac transplantation, had CKD Stage 5 or ESRD requiring dialysis were excluded. Patients were defined as either persistent WRF (WRFp), or transient WRF (WRFt) or non-WRF. WRFp patients had $ 0.3 mg/dL and a $ 25% increase from baseline SCr that persisted at discharge whereas WRFt patients had $ 0.3 mg/dL and a $ 25% increase from baseline SCr that did not persist at discharge. Non-WRF patients were those who neither classified as WRFp nor WRFt. Patient and hospital characteristics were compared by renal function groups using Chi-square and rank sum tests for the index hospitalization, and for cu- mulative time windows of 30, 180 and 365 days post discharge. Multivariable GLM models examined the relationship between renal function groups, LOS and costs. Results: 55,436 AHF patients, of whom 77% were Non-WRF, 10% were WRFp and 13% were WRFt, were selected. The total population had a mean age of 72.4 (614.3) years and 53% were female. WRFp patients had higher rates of cancer, sepsis, and chronic liver disease than WRFt patients (p!0.01). WRFt patients had significantly longer average LOS (13.6 days vs. 10.2 days vs. 7.5 days, p!0.0001) and total costs ($38,412 vs. $29,252 vs. $20,137, p!0.0001) than WRFp and Non-WRF patients during the index hospitalization. This trend was also observed across the other cumulative time points and was confirmed in the multivariable Figure. Figure. Outcomes Stratified by Resting Cardiac Index (CI) and Percent Predicted Peak Oxygen Consumption (%VO 2 ). Groups are divided above and below median values for the cohort, i.e. decreased CI is !2.0 L/min/m2 and decreased %VO 2 is !55%. S50 Journal of Cardiac Failure Vol. 20 No. 8S August 2014