Diuretic strategies in patients with acute decompensated heart failure
G Michael Felker, Kerry L Lee, David A Bull, Margaret M Redfield, Lynne W Stevenson, Steven R Goldsmith, Martin M LeWinter, Anita Deswal, Jean L Rouleau, Elizabeth O Ofili, Kevin J Anstrom, Adrian F Hernandez, Steven E McNulty, Eric J Velazquez, Abdallah G Kfoury, Horng H Chen, Michael M Givertz, Marc J Semigran, Bradley A Bart, Alice M Mascette, Eugene Braunwald, Christopher M O'Connor, NHLBI Heart Failure Clinical Research Network, Eugene Braunwald, Alice Mascette, Anthony Agresti, Robin Boineau, Patrice Desvigne-Nickens, Julianna Keleti, Monica Shah, George Sopko, Minjung Kwak, Kerry Lee, Kevin Anstrom, Adrian Hernandez, Steve McNulty, Eric Velazquez, Michael Booth, Anita Deswal, Adrienne Chee, Christopher O'Connor, Michael Felker, Joseph Rogers, Patti Adams, Kathleen Rohrback, Lynne Stevenson, Marc Semigran, Michael Givertz, Mary Susan Anello, Kimberly Brooks, Diane Cocca-Spofford, Margaret Redfield, Horng Chen, Janet Gatzke, Ruth Larson, Susan Nelson, Steven Goldsmith, Bradley Bart, Shari Mackedanz, Elizabeth Ofili, Raquel Bennett, Adefisayo Oduwole, Anekwe Onwuanyi, Rigobert Lapu-Bula, Paul Douglass, Abiodun Olatidoye, Brenda Lankford, Sunday Nkemdiche, Priscilla Johnson, Jean Rouleau, Helene Brown, David Bull, Abdallah G Kfoury, Joseph Stehlik, Neal Mehta, Patty Meldrum, Kirk Volkman, Martin LeWinter, Linda Chadwick, Michaelanne Rowen, Russell P Tracy, Rebekah Boyle, Elaine Cornell, Douglas Vaughan, Julie Johnson, Jessica Wilen Berg, Maryl R Johnson, Kathryn Davis Kennedy, Donald Landry, Barry Greenberg, Joseph Parrillo, Marc Penn, Eric A Rose, William Abraham, Dennis McNamara, Jessica Wilen Berg, Joseph Parrillo, Jiawen Cai, J Perren Cobb, Eric A Rose, Douglas Vaughan, Renu Virmani, G Michael Felker, Kerry L Lee, David A Bull, Margaret M Redfield, Lynne W Stevenson, Steven R Goldsmith, Martin M LeWinter, Anita Deswal, Jean L Rouleau, Elizabeth O Ofili, Kevin J Anstrom, Adrian F Hernandez, Steven E McNulty, Eric J Velazquez, Abdallah G Kfoury, Horng H Chen, Michael M Givertz, Marc J Semigran, Bradley A Bart, Alice M Mascette, Eugene Braunwald, Christopher M O'Connor, NHLBI Heart Failure Clinical Research Network, Eugene Braunwald, Alice Mascette, Anthony Agresti, Robin Boineau, Patrice Desvigne-Nickens, Julianna Keleti, Monica Shah, George Sopko, Minjung Kwak, Kerry Lee, Kevin Anstrom, Adrian Hernandez, Steve McNulty, Eric Velazquez, Michael Booth, Anita Deswal, Adrienne Chee, Christopher O'Connor, Michael Felker, Joseph Rogers, Patti Adams, Kathleen Rohrback, Lynne Stevenson, Marc Semigran, Michael Givertz, Mary Susan Anello, Kimberly Brooks, Diane Cocca-Spofford, Margaret Redfield, Horng Chen, Janet Gatzke, Ruth Larson, Susan Nelson, Steven Goldsmith, Bradley Bart, Shari Mackedanz, Elizabeth Ofili, Raquel Bennett, Adefisayo Oduwole, Anekwe Onwuanyi, Rigobert Lapu-Bula, Paul Douglass, Abiodun Olatidoye, Brenda Lankford, Sunday Nkemdiche, Priscilla Johnson, Jean Rouleau, Helene Brown, David Bull, Abdallah G Kfoury, Joseph Stehlik, Neal Mehta, Patty Meldrum, Kirk Volkman, Martin LeWinter, Linda Chadwick, Michaelanne Rowen, Russell P Tracy, Rebekah Boyle, Elaine Cornell, Douglas Vaughan, Julie Johnson, Jessica Wilen Berg, Maryl R Johnson, Kathryn Davis Kennedy, Donald Landry, Barry Greenberg, Joseph Parrillo, Marc Penn, Eric A Rose, William Abraham, Dennis McNamara, Jessica Wilen Berg, Joseph Parrillo, Jiawen Cai, J Perren Cobb, Eric A Rose, Douglas Vaughan, Renu Virmani
Abstract
Background: Loop diuretics are an essential component of therapy for patients with acute decompensated heart failure, but there are few prospective data to guide their use.
Methods: In a prospective, double-blind, randomized trial, we assigned 308 patients with acute decompensated heart failure 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.
Results: In the comparison of bolus with continuous infusion, there was no significant difference in patients' global assessment of symptoms (mean AUC, 4236±1440 and 4373±1404, respectively; P=0.47) or in the mean change in the creatinine level (0.05±0.3 mg per deciliter [4.4±26.5 μmol per liter] and 0.07±0.3 mg per deciliter [6.2±26.5 μmol per liter], respectively; P=0.45). 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, 4430±1401 vs. 4171±1436; P=0.06). There was no significant difference between these groups in the mean change in the creatinine level (0.08±0.3 mg per deciliter [7.1±26.5 μmol per liter] with the high-dose strategy and 0.04±0.3 mg per deciliter [3.5±26.5 μmol per liter] with the low-dose strategy, P=0.21). 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.
Conclusions: 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. (Funded by the National Heart, Lung, and Blood Institute; ClinicalTrials.gov number, NCT00577135.).
Conflict of interest statement
No other potential conflict of interest relevant to this article was reported.
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Source: PubMed