Diuretic strategies in patients with acute decompensated heart failure

January 01, 0001

Diuretic strategies in patients with acute decompensated heart failure

These US investigators conducted a prospective, double-blind, randomized trial, including 308 patients with acute decompensated heart failure. They were assigned to receive furosemide administered intravenously by means of either a bolus every 12 hours or continuous infusion and at either a low dose (equivalent to the patient's previous oral dose) or a high dose (2.5 times the previous oral dose). The protocol allowed specified dose adjustments after 48 hours. The coprimary end points were patients' global assessment of symptoms, quantified as the area under the curve (AUC) of the score on a visual-analogue scale over the course of 72 hours, and the change in the serum creatinine level from baseline to 72 hours.

They found: "In the comparison of bolus with continuous infusion, there was no significant difference in patients' global assessment of symptoms (mean AUC, 4236 and 4373, respectively) or in the mean change in the creatinine level (0.05mg per deciliter and 0.07mg per deciliter, respectively). In the comparison of the high-dose strategy with the low-dose strategy, there was a nonsignificant trend toward greater improvement in patients' global assessment of symptoms in the high-dose group (mean AUC, 4430vs. 4171). There was no significant difference between these groups in the mean change in the creatinine level (0.08mg per deciliter with the high-dose strategy and 0.04mg per deciliter with the low-dose strategy). The high-dose strategy was associated with greater diuresis and more favorable outcomes in some secondary measures but also with transient worsening of renal function."

The authors concluded: "Among patients with acute decompensated heart failure, there were no significant differences in patients' global assessment of symptoms or in the change in renal function when diuretic therapy was administered by bolus as compared with continuous infusion or at a high dose as compared with a low dose."

Either approach appears to be appropriate. However, the study was too small to assess risk for rare adverse outcomes.

For the full abstract, click here.

N Engl J Med 364:797-805, 3 March 2011 © 2011 to the Massachusetts Medical Society
Diuretic Strategies in Patients with Acute Decompensated Heart Failure. G. Michael Felker, Kerry L. Lee, David A. Bull, et al. Correspondence to Dr. Felker: [email protected]

Category: K. Circulatory. Keywords: heart failure, diuretics, furosemide, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 22 March 2011

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