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Cited by 1,721

The DOI matches its Crossref record; 1 of the 1 references it cites were found in a registry or an index.

Diuretic Strategies in Patients with Acute Decompensated Heart Failure

Open access
Felker, G. Michael, Lee, Kerry L., Bull, David A., Redfield, Margaret M., Stevenson, Lynne W., Goldsmith, Steven R., LeWinter, Martin M., Deswal, Anita, Rouleau, Jean L., Ofili, Elizabeth O., Anstrom, Kevin J., Hernandez, Adrian F., McNulty, Steven E., Velazquez, Eric J., Kfoury, Abdallah G., Chen, Horng H., Givertz, Michael M., Semigran, Marc J., Bart, Bradley A., Mascette, Alice M., Braunwald, Eugene, O'Connor, Christopher M.·2011·New England Journal of Medicine
DOI 10.1056/nejmoa1005419
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Abstract

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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Metadata

Authors
Felker, G. M., Lee, K. L., Bull, D. A., Redfield, M. M., Stevenson, L. W., Goldsmith, S. R., LeWinter, M. M., Deswal, A., Rouleau, J. L., Ofili, E. O., Anstrom, K. J., Hernandez, A. F., McNulty, S. E., Velazquez, E. J., Kfoury, A. G., Chen, H. H., Givertz, M. M., Semigran, M. J., Bart, B. A., Mascette, A. M., Braunwald, E., & O'Connor, C. M.
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2011-03-03
Volume
364
Issue
9
Pages
797-805
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa1005419
OpenAlex
W2139359396
Cited by
1,721
References
1
FWCI
81.00
Type
journal article
Language
en
Open access
bronze

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