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Randomized Evaluation of Heart Failure With Preserved Ejection Fraction Patients With Acute Heart Failure and Dopamine: The ROPA-DOP Trial.

Publication ,  Journal Article
Sharma, K; Vaishnav, J; Kalathiya, R; Hu, J-R; Miller, J; Shah, N; Hill, T; Sharp, M; Tsao, A; Alexander, KM; Gupta, R; Montemayor, K ...
Published in: JACC Heart Fail
October 2018

OBJECTIVES: This study sought to compare a continuous infusion diuretic strategy versus an intermittent bolus diuretic strategy, with the addition of low-dose dopamine (3 μg/kg/min) in the treatment of hospitalized patients with heart failure with preserved ejection fraction (HFpEF). BACKGROUND: HFpEF patients are susceptible to development of worsening renal function (WRF) when hospitalized with acute heart failure; however, inpatient treatment strategies to achieve safe and effective diuresis in HFpEF patients have not been studied to date. METHODS: In a prospective, randomized, clinical trial, 90 HFpEF patients hospitalized with acute heart failure were randomized within 24 h of admission to 1 of 4 treatments: 1) intravenous bolus furosemide administered every 12 h; 2) continuous infusion furosemide; 3) intermittent bolus furosemide with low-dose dopamine; and 4) continuous infusion furosemide with low-dose dopamine. The primary endpoint was percent change in creatinine from baseline to 72 h. Linear and logistic regression analyses with tests for interactions between diuretic and dopamine strategies were performed. RESULTS: Compared to intermittent bolus strategy, the continuous infusion strategy was associated with higher percent increase in creatinine (continuous infusion: 16.01%; 95% confidence interval [CI]: 8.58% to 23.45% vs. intermittent bolus: 4.62%; 95% CI: -1.15% to 10.39%; p = 0.02). Low-dose dopamine had no significant effect on percent change in creatinine (low-dose dopamine: 12.79%; 95% CI: 5.66% to 19.92%, vs. no-dopamine: 8.03%; 95% CI: 1.44% to 14.62%; p = 0.33). Continuous infusion was also associated with greater risk of WRF than intermittent bolus (odds ratio [OR]: 4.32; 95% CI: 1.26 to 14.74; p = 0.02); no differences in WRF risk were seen with low-dose dopamine. No significant interaction was seen between diuretic strategy and low-dose dopamine (p > 0.10). CONCLUSIONS: In HFpEF patients hospitalized with acute heart failure, low-dose dopamine had no significant impact on renal function, and a continuous infusion diuretic strategy was associated with renal impairment. (Diuretics and Dopamine in Heart Failure With Preserved Ejection Fraction [ROPA-DOP]; NCT01901809).

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Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

October 2018

Volume

6

Issue

10

Start / End Page

859 / 870

Location

United States

Related Subject Headings

  • Stroke Volume
  • Middle Aged
  • Male
  • Injections, Intravenous
  • Infusions, Intravenous
  • Humans
  • Heart Failure
  • Furosemide
  • Female
  • Drug Therapy, Combination
 

Citation

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ICMJE
MLA
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Sharma, K., Vaishnav, J., Kalathiya, R., Hu, J.-R., Miller, J., Shah, N., … Osler Medical Housestaff, . (2018). Randomized Evaluation of Heart Failure With Preserved Ejection Fraction Patients With Acute Heart Failure and Dopamine: The ROPA-DOP Trial. JACC Heart Fail, 6(10), 859–870. https://doi.org/10.1016/j.jchf.2018.04.008
Sharma, Kavita, Joban Vaishnav, Rohan Kalathiya, Jiun-Ruey Hu, John Miller, Nishant Shah, Terence Hill, et al. “Randomized Evaluation of Heart Failure With Preserved Ejection Fraction Patients With Acute Heart Failure and Dopamine: The ROPA-DOP Trial.JACC Heart Fail 6, no. 10 (October 2018): 859–70. https://doi.org/10.1016/j.jchf.2018.04.008.
Sharma K, Vaishnav J, Kalathiya R, Hu J-R, Miller J, Shah N, et al. Randomized Evaluation of Heart Failure With Preserved Ejection Fraction Patients With Acute Heart Failure and Dopamine: The ROPA-DOP Trial. JACC Heart Fail. 2018 Oct;6(10):859–70.
Sharma, Kavita, et al. “Randomized Evaluation of Heart Failure With Preserved Ejection Fraction Patients With Acute Heart Failure and Dopamine: The ROPA-DOP Trial.JACC Heart Fail, vol. 6, no. 10, Oct. 2018, pp. 859–70. Pubmed, doi:10.1016/j.jchf.2018.04.008.
Sharma K, Vaishnav J, Kalathiya R, Hu J-R, Miller J, Shah N, Hill T, Sharp M, Tsao A, Alexander KM, Gupta R, Montemayor K, Kovell L, Chasler JE, Lee YJ, Fine DM, Kass DA, Weiss RG, Thiemann DR, Ndumele CE, Schulman SP, Russell SD, Osler Medical Housestaff. Randomized Evaluation of Heart Failure With Preserved Ejection Fraction Patients With Acute Heart Failure and Dopamine: The ROPA-DOP Trial. JACC Heart Fail. 2018 Oct;6(10):859–870.
Journal cover image

Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

October 2018

Volume

6

Issue

10

Start / End Page

859 / 870

Location

United States

Related Subject Headings

  • Stroke Volume
  • Middle Aged
  • Male
  • Injections, Intravenous
  • Infusions, Intravenous
  • Humans
  • Heart Failure
  • Furosemide
  • Female
  • Drug Therapy, Combination