Detalles

Escrito por Thaismel J. Ojeda R.

Creado: 21 Mayo 2015

Visto: 3106

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.)

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