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Diuretic treatment in high-risk acute decompensation of advanced chronic heart failure—bolus intermittent vs. continuous infusion of furosemide: a randomized controlled trial

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A Letter to the Editors to this article was published on 11 October 2019

Abstract

Background

Diuretic resistance is a common issue in patients with acute decompensation of advanced chronic heart failure (ACHF). The aim of this trial was to compare boluses and continuous infusion of furosemide in a selected population of patients with ACHF and high risk for diuretic resistance.

Methods

In this single-centre, double-blind, double-dummy, randomized trial, we enrolled 80 patients admitted for acute decompensation of ACHF (NYHA IV, EF ≤ 30%) with criteria of high risk for diuretic resistance (SBP ≤ 110 mmHg, wet score ≥ 12/18, and sodium ≤ 135 mMol/L). Patients were assigned in a 1:1 ratio to receive furosemide by bolus every 12 h or by continuous infusion. Diuretic treatment and dummy treatment were prepared by a nurse unassigned to patients’ care. The study treatment was continued for up to 72 h. Coprimary endpoints were total urinary output and freedom from congestion at 72 h.

Results

80 patients were enrolled with 40 patients in each treatment arm. Mean daily furosemide was 216 mg in continuous-infusion arm and 195 mg in the bolus intermittent arm. Freedom from congestion (defined as jugular venous pressure of < 8 cm, with no orthopnea and with trace peripheral edema or no edema) occurred more in the continuous infusion than in the bolus arm (48% vs. 25%, p = 0.04), while total urinary output after 72 h was 8612 ± 2984 ml in the bolus arm and 10,020 ± 3032 ml in the continuous arm (p = 0.04). Treatment failure occurred less in the continuous-infusion group (15% vs. 38%, p = 0.02), while there was no significant difference between groups in the incidence of worsening of renal function.

Conclusion

Among patients with acute decompensation of ACHF and high risk of diuretic resistance, continuous infusion of intravenous furosemide was associated with better decongestion.

DRAIN trial

ClinicalTrials.gov number NCT03592836.

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Authors and Affiliations

  1. Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza University Hospital of Turin, Corso Bramante 88, 10126, Turin, Italy

    Simone Frea, Stefano Pidello, Alessandra Volpe, Federico Giovanni Canavosio, Alessandro Galluzzo, Virginia Bovolo, Antonio Camarda, Pier Giorgio Golzio, Fabrizio D’Ascenzo, Serena Bergerone, Mauro Rinaldi & Fiorenzo Gaita

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  1. Simone Frea
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  2. Stefano Pidello
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  3. Alessandra Volpe
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  4. Federico Giovanni Canavosio
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  5. Alessandro Galluzzo
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  6. Virginia Bovolo
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Correspondence to Simone Frea.

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Frea, S., Pidello, S., Volpe, A. et al. Diuretic treatment in high-risk acute decompensation of advanced chronic heart failure—bolus intermittent vs. continuous infusion of furosemide: a randomized controlled trial. Clin Res Cardiol 109, 417–425 (2020). https://doi.org/10.1007/s00392-019-01521-y

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