Diuretic Strategies in Patients With Acute Decompesated Heart

7/29/2019 Diuretic Strategies in Patients With Acute Decompesated Heart

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NEJM

Diuretic strategies in patients with

acute decompesated heart failure


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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.


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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 patients previous oral dose) or a high dose

(2.5 times the previousoral dose).


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Conclusions


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Bolus vs countinuous infusion

There was no significant difference between thetwo treatment groups in the primary efficacy end

point of patient-reported global assessment of

symptoms (mean AUC, 42361440 with boluses

and 43731404 with continuous infusion; P =0.47) (Fig. 1). There was also no significant

between-group difference in the primary safety

end point of the change in serum creatinine level

from baseline to 72 hours (mean change increatinine level, 0.050.3 mg per deciliter

[4.426.5 mol per liter] with boluses and

0.070.3 mg per deciliter [6.226.5 mol per liter]

with continuous infusion; P = 0.45)


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Oral rute


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There was a nonsignificant trend toward greaterimprovement in the primary efficacy end point in

the high-dose group than in the low-dose group

(mean AUC, 44301401 vs. 41711436; P =

0.06) (Fig. 1). There was no significant differencebetween these two treatment groups in the

between the bolus group and the

continuousinfusion group in the proportion of

patients with serious adverse events (44% ineach group, P = 0.92).


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The mean change in the serum creatinine level

over

the course of the 72-hour.


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Conclusions

In conclusion, among patients with acutedecompensated heart failure and moderate-to-

high baseline diuretic requirements, there were

no significant differences in the patients global

assessment of symptoms or in changes frombaseline renal function with either bolus as

compared with continuous infusion of intravenous

furosemide or with a low-dose strategy as

compared with a highdose strategy.


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References Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke

statistics 2009 update: a report from the American Heart Association

Statistics Committee and Stroke Statistics Subcommittee. Circulation

2009;119(3):e21-e181.

2. Emerman CL, Marco TD, Costanzo MR, Peacock WF. Impact of

intravenous diuretics on the outcomes of patients hospitalized with

acute decompensated heart failure: insights from the ADHERE(R)

Registry. J Card Fail 2004;10:Suppl:S116- S117.

Jessup M, Abraham WT, Casey DE, et al. 2009 Focused update:

ACCF/AHA Guidelines for the Diagnosis and Management of Heart

Failure in Adults: a report of the American College of Cardiology

Foundation/ American Heart Association Task Force on PracticeGuidelines: developed in collaboration with the International Society for

Heart and Lung Transplantation.Circulation 2009;119:1977-2016.

4. Adams KF, Lindenfeld J, Arnold JM, et al. HFSA 2006

comprehensive heart failure practice guideline. J Card Fail 2006;12:1-

119. FelkerGM, OConnor CM, Braunwald E. Loop diuretics in acute

decompensated heart failure: necessary? Evil? A necessary evil? Circ

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Thaankz yoooou

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Diuretic Strategies in Patients With Acute Decompesated Heart

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