Continuous Versus Intermittent Infusion of Furosemide in Acute Decompensated Heart Failure

Thomson, Margaret R.; Nappi, Jean M.; Dunn, Steven P.; Hollis, Ian B.; Rodgers, Jo E.; Van Bakel, Adrian B.

doi:10.1016/j.cardfail.2009.11.005

« Previous Next »Journal of Cardiac Failure
Volume 16, Issue 3 , Pages 188-193, March 2010

Continuous Versus Intermittent Infusion of Furosemide in Acute Decompensated Heart Failure

Margaret R. Thomson, PharmD, BCPS
- Baptist Hospital, Saint Thomas Health Services, Nashville, TN
Jean M. Nappi, PharmD, BCPS
- South Carolina College of Pharmacy, Charleston, SC
- Medical University of South Carolina, Charleston, SC
Steven P. Dunn, PharmD, BCPS
- University of Kentucky Chandler Medical Center, Lexington, KY
Ian B. Hollis, PharmD, BCPS
- University of North Carolina, School of Pharmacy and Hospitals, Chapel Hill, NC
Jo E. Rodgers, PharmD, BCPS
- University of North Carolina, School of Pharmacy and Hospitals, Chapel Hill, NC
Adrian B. Van Bakel, MD, PhD
- Medical University of South Carolina, Charleston, SC
- Reprint requests: Adrian B. Van Bakel MD, PhD, Division of Cardiology, Medical University of South Carolina, 25 Courtenay Dr. MSC 592, Charleston, SC 29425. Tel: 843-876-4790; Fax: 843-876-4809.

Received 19 March 2009; received in revised form 11 November 2009; accepted 24 November 2009. published online 06 January 2010.

Abstract

Background

Despite advances in the treatment of chronic ambulatory heart failure, hospitalization rates for acute decompensated heart failure (ADHF) remain high. Although loop diuretics are used in nearly all patients with ADHF to relieve congestive symptoms, optimal dosing strategies remain poorly defined.

Methods and Results

This was a prospective, randomized, parallel-group study comparing the effectiveness of continuous intravenous (cIV) with intermittent intravenous (iIV) infusion of furosemide in 56 patients with ADHF. The dose and duration of furosemide as well as concomitant medications to treat ADHF were determined by physician preference. The primary end point of the study was net urine output (nUOP)/24hours. Safety measures including electrolyte loss and hemodynamic instability were also assessed.

Twenty-six patients received cIV and 30 patients received iIV dosing. The mean nUOP/24hours was 2098±1132mL in patients receiving cIV versus 1575±1100mL in the iIV group (P=.086). The cIV group had significantly greater total urine output (tUOP) with 3726±1121mL/24hours versus 2955±1267mL/24hours in the iIV group (P=.019) and tUOP/mg furosemide with 38.0±31.0mL/mg versus 22.2±12.5mL/mg (P=.021). Mean weight loss was not significantly different between the groups. The cIV group experienced a shorter length of hospital stay (6.9±3.7 versus 10.9±8.3 days, P=.006). There were no differences in safety measures between the groups.

Conclusions

The cIV of furosemide was well tolerated and significantly more effective than iIV for tUOP. In addition, continuous infusion appears to provide more efficient diuresis.

Key Words: Diuretics, furosemide, heart failure