Heart Failure Patients Don't Need Continuous Infusion of
WEDNESDAY, March 2 (HealthDay News) -- Answering lingering
questions about the treatment of acute heart failure, investigators
have determined that there are no real differences in how patients
fare when they're given diuretic therapy one dose at a time or
Nor was there any real difference in outcomes with the lower
versus the higher dose, although there was a trend toward
improvement the higher the doctors went.
These findings should make decisions easier for the doctors
around the United States who treat the one million heart failure
patients who are hospitalized each year.
"Today doctors all over the U.S. are having to make a decision on how to give diuretics. This gives insight as to the trade-off between efficacy and safety in each decision," said Dr. Michael Felker, lead author of a study appearing in the March 3 issue of the New England Journal of Medicine.
Loop diuretics have been the mainstay of treatment for acute
heart failure for 40 or 50 years, but because the drugs were
introduced so long ago, they weren't subject to the rigorous
evaluation that today's pharmaceuticals undergo before hitting the
Scientists are on the hunt for newer and better treatments for
acute heart failure, but in the meantime, diuretics are the
As a result, Felker said, "for 40 years, we were basically doing
things based on clinical impressions, anecdotal experience, the way
that a particular [doctor] was used to doing it. This is the first
time we have high-quality data from a randomized controlled trial
to help inform that decision."
For this study, 308 patients with acute decompensated heart
failure were randomly divided into two groups. One was to receive
furosemide (Lasix), the most commonly used diuretic for heart
failure, intravenously by a bolus every 12 hours; the other would
get it by continuous infusion, and both groups would get high and
Symptoms and measures of kidney function after 72 hours were
about the same in each group.
But looking more closely at the data, the researchers found "a
pretty strong suggestion that the high doses are actually better,"
said Felker, associate professor of medicine at Duke University
Medical Center in Durham, N.C.
This goes against the grain of what people had been thinking:
that high doses might be dangerous, he said. Also, many people had
thought continuous administration was probably better but, Felker
said, "the results were completely neutral. There was no
"This study shows that as a general strategy, it is reasonable to use IV bolus dosing instead of continuous infusion dosing of furosemide for patients hospitalized with heart failure," said Dr. Stuart Katz, director of the Heart Failure Program at New York University Langone Medical Center in New York City.
"This is important because the continuous infusion is more expensive," he said. Also, the IV pole needed for the pump hampers the patient's ability to walk around, he noted.
But the study also showed that "the post-discharge event rates
for patients hospitalized with heart failure is extremely high,"
Katz added. "Much more work is needed to develop effective
strategies to reduce this risk."
An editorial accompanying the study echoed this sentiment. The
trial "underscores the dismal prognosis for patients with acute
decompensated heart failure," wrote Dr. Gregg Fonarow of the
University of California at Los Angeles.
Fonarow commended the study for introducing the concept of
comparative-effectiveness studies into the field of heart-failure
"In this well-conducted study, performed at institutions that have highly regarded programs for patients with heart failure, there was an unacceptably high (43%) rate of death, rehospitalization, or emergency department visits within the first 60 days, irrespective of treatment assignment," he said.
"Clearly, there is a crucial need to develop new agents and effective strategies for this patient population," he concluded.
The American Heart Association has more on
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