BACKGROUND: Acute decompensated heart failure (ADHF) treatment guidelines recommend initial dosages for diuretic drugs but lack guidance on treatment timing. Recent evidence indicates that faster treatment, or shorter Door-to-Diuretic (D2D) Time, may improve outcomes. OBJECTIVES: This study assessed how diuretic dose, D2D Time, and their interaction affect hospital length of stay. METHODS: Data were analyzed from medical records of ADHF patients in the emergency department of a large academic center. We calculated the odds of longer hospitalization (>
7 days) based on diuretic dose, D2D Time, and their interaction, adjusting for age, sex, race, NYHA class, creatinine levels, systolic blood pressure, and comorbidity burden. RESULTS: Our sample of 198 patients who were hospitalized a total of 275 times (mean: 1.48±0.99 hospitalizations) were predominantly male (57 %), older (71, IQR:18.5), years), overweight/obese (30.12, IQR: 11.66 kg/m CONCLUSION: D2D Time significantly predicts prolonged hospitalization independently of diuretic dosing, highlighting a need for revised ADHF guidelines that include both diuretic dosing and timely administration. Further research is essential to refine these recommendations.