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Diuretic strategies in patients with acute decompensated heart failure.

Publication ,  Journal Article
Felker, GM; Lee, KL; Bull, DA; Redfield, MM; Stevenson, LW; Goldsmith, SR; LeWinter, MM; Deswal, A; Rouleau, JL; Ofili, EO; Anstrom, KJ ...
Published in: N Engl J Med
March 3, 2011

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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Published In

N Engl J Med

DOI

EISSN

1533-4406

Publication Date

March 3, 2011

Volume

364

Issue

9

Start / End Page

797 / 805

Location

United States

Related Subject Headings

  • Sodium Potassium Chloride Symporter Inhibitors
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Intention to Treat Analysis
  • Injections, Intravenous
  • Infusions, Intravenous
  • Humans
  • Heart Failure
  • General & Internal Medicine
 

Citation

APA
Chicago
ICMJE
MLA
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Felker, G. M., Lee, K. L., Bull, D. A., Redfield, M. M., Stevenson, L. W., Goldsmith, S. R., … NHLBI Heart Failure Clinical Research Network, . (2011). Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med, 364(9), 797–805. https://doi.org/10.1056/NEJMoa1005419
Felker, G Michael, Kerry L. Lee, David A. Bull, Margaret M. Redfield, Lynne W. Stevenson, Steven R. Goldsmith, Martin M. LeWinter, et al. “Diuretic strategies in patients with acute decompensated heart failure.N Engl J Med 364, no. 9 (March 3, 2011): 797–805. https://doi.org/10.1056/NEJMoa1005419.
Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011 Mar 3;364(9):797–805.
Felker, G. Michael, et al. “Diuretic strategies in patients with acute decompensated heart failure.N Engl J Med, vol. 364, no. 9, Mar. 2011, pp. 797–805. Pubmed, doi:10.1056/NEJMoa1005419.
Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, LeWinter MM, Deswal A, Rouleau JL, Ofili EO, Anstrom KJ, Hernandez AF, McNulty SE, Velazquez EJ, Kfoury AG, Chen HH, Givertz MM, Semigran MJ, Bart BA, Mascette AM, Braunwald E, O’Connor CM, NHLBI Heart Failure Clinical Research Network. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011 Mar 3;364(9):797–805.

Published In

N Engl J Med

DOI

EISSN

1533-4406

Publication Date

March 3, 2011

Volume

364

Issue

9

Start / End Page

797 / 805

Location

United States

Related Subject Headings

  • Sodium Potassium Chloride Symporter Inhibitors
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Intention to Treat Analysis
  • Injections, Intravenous
  • Infusions, Intravenous
  • Humans
  • Heart Failure
  • General & Internal Medicine