Continuous Versus Bolus Dosing of Furosemide for Patients Hospitalized for Heart Failure

Larry A. Allen, Aslan T. Turer, Tracy DeWald, Wendy Gattis Stough, Gadi Cotter, Christopher M. O'Connor

Research output: Contribution to journalArticle

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Abstract

Intravenous diuretics are the cornerstone of management for patients hospitalized for heart failure. Physiologic data suggest that intermittent high-dose furosemide promotes neurohormonal activation, which a slow continuous infusion might remediate. However, the limited clinical data comparing dosing schemes are confounded. This study was a randomized, open-label, single-center trial of twice-daily bolus injection versus continuous infusion furosemide in patients hospitalized with heart failure and volume overload. The primary outcome was change in creatinine from admission to hospital day 3 or discharge. Twenty-one patients were randomized to bolus injection and 20 patients to continuous infusion. Baseline characteristics were balanced between study arms except for gender, with a mean age of 60 ± 15 years, a mean ejection fraction of 35 ± 19%, and a mean creatinine level of 1.9 ± 1.2 mg/dl. The mean doses of furosemide were similar between arms over the first 48 hours (162 ± 48 and 162 ± 52 mg/24 hours). None of the outcomes differed significantly between bolus and continuous dosing from admission to hospital day 3 or discharge (mean change in creatinine -0.02 vs 0.13 mg/dl, p = 0.18; urine output 5,113 vs 4,894 ml, p = 0.78; length of stay 8.8 vs 9.9 days, p = 0.69). All patients survived to discharge. In conclusion, there were no substantial differences between bolus injection and continuous infusion of equal doses of furosemide for the treatment of patients hospitalized with heart failure. Given the high prevalence of heart failure hospitalization and the disparate results of small studies regarding optimal dosing of loop diuretics to treat these patients, larger multicenter blinded studies are needed.

Original languageEnglish (US)
Pages (from-to)1794-1797
Number of pages4
JournalAmerican Journal of Cardiology
Volume105
Issue number12
DOIs
StatePublished - Jun 15 2010

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Furosemide
Heart Failure
Creatinine
Injections
Sodium Potassium Chloride Symporter Inhibitors
Cardiac Volume
Diuretics
Multicenter Studies
Length of Stay
Hospitalization
Urine

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Continuous Versus Bolus Dosing of Furosemide for Patients Hospitalized for Heart Failure. / Allen, Larry A.; Turer, Aslan T.; DeWald, Tracy; Stough, Wendy Gattis; Cotter, Gadi; O'Connor, Christopher M.

In: American Journal of Cardiology, Vol. 105, No. 12, 15.06.2010, p. 1794-1797.

Research output: Contribution to journalArticle

Allen, Larry A. ; Turer, Aslan T. ; DeWald, Tracy ; Stough, Wendy Gattis ; Cotter, Gadi ; O'Connor, Christopher M. / Continuous Versus Bolus Dosing of Furosemide for Patients Hospitalized for Heart Failure. In: American Journal of Cardiology. 2010 ; Vol. 105, No. 12. pp. 1794-1797.
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