Diuretic treatment in high-risk acute decompensation of advanced chronic heart failure—bolus intermittent vs. continuous infusion of furosemide: a randomized controlled trial
- 942 Downloads
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.
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.
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.
Among patients with acute decompensation of ACHF and high risk of diuretic resistance, continuous infusion of intravenous furosemide was associated with better decongestion.
ClinicalTrials.gov number NCT03592836.
KeywordsDiuretic resistance Advanced heart failure Furosemide Bolus intermittent Continuous infusion
Compliance with ethical standards
Conflict of interest
The author declares that they have no competing interests.
- 9.Gheorghiade M, Follath F, Ponikowski P et al (2010) European society of cardiology; European society of intensive care medicine. Assessing and grading congestion in acute heart failure: a scientific statement from the acute heart failure committee of the heart failure association of the European society of cardiology and endorsed by the European society of intensive care medicine. Eur J Heart Fail 12:423–433PubMedCrossRefGoogle Scholar
- 11.Ambrosio G, Di Lenarda A, Fedele F, Gabrielli D, Metra M, Oliva F, Perna G, Senni M, De Maria R (2009) Inotrope therapy in acute heart failure: a critical review of clinical and scientific evidence for levosimendan in the context of traditional treatment. Giomale Ital Cardiol 10:422–433Google Scholar
- 14.Frea S, Centofanti P, Pidello S, Giordana F, Bovolo V, Baronetto A, Franco B, Cingolani MM, Attisani M, Morello M, Bergerone S, Rinaldi M, Gaita F (2018) Noninvasive assessment of hemodynamic status in Heart-Ware left ventricular assist device patients: validation of an echocardiographic approach. JACC Cardiovasc Imaging. https://doi.org/10.1016/j.jcmg.2018.01.026 PubMedCrossRefGoogle Scholar
- 15.Frea S, Pidello S, Bovolo V, Iacovino C, Franco E, Pinneri F, Galluzzo A, Volpe A, Visconti M, Peirone A, Morello M, Bergerone S, Gaita F (2016) Prognostic incremental role of right ventricular function in acute decompensation of advanced chronic heart failure. Eur J Heart Fail 18(5):564–572PubMedCrossRefGoogle Scholar
- 23.Metra M, Davison B, Bettari L, Sun H, Edwards C, Lazzarini V, Piovanelli B, Carubelli V, Bugatti S, Lombardi C, Cotter G, Dei Cas L (2012) Is worsening renal function an ominous prognostic sign in patients with acute heart failure? The role of congestion and its interaction with renal function. Circ Heart Fail 5(1):54–62PubMedCrossRefGoogle Scholar