Aggressive diuresis for severe heart failure in the elderly

To determine the efficacy, safety, and economic benefit of continuous IV infusion of furosemide as a treatment modality for elderly patients with class IV heart failure.

Prospective trial of consecutively admitted elderly patients > 65 years old with class IV heart failure.

A single cardiovascular service in a university medical center.

Seventeen male and female patients > 65 years old consecutively admitted to a cardiovascular service.

High-dose, continuous IV infusion of furosemide was successful in providing a 9- to 20-L diuresis in an average of 3.5 days without causing clinical complications or aberrations in blood chemistry. The length of stay was 2.3 days shorter than a contemporary group of class III and class IV elderly patients with heart failure managed on other medical services. The Medicare reimbursement for heart failure was $6,047. Patients receiving IV bolus diuretic therapy incurred billing charges of $10,193, or a loss of $4,146 per patient to the hospital. Patients receiving diuretic infusion therapy incurred billing charges of $4,944. This was a difference of $5,249 per patient treated by continuous IV infusion compared to bolus therapy and a profit per Medicare patient of $1,103. Therefore, a $4,146 billing loss was converted to $1,103 profit.

IV furosemide infusion therapy for class IV heart failure in the elderly is a safe, effective, and economic mode of therapy.