Severe heart failure in the elderly: potential benefits of high-dose and continuous infusion diuretics

Heart failure (HF) is a growing problem among the elderly that results in significant morbidity and mortality. Congestive symptoms because of sodium and water retention are a major cause of impaired functional capacity and frequent hospitalisations. Patients with severe HF often develop resistance to traditional doses of diuretics. Subtherapeutic diuretic regimens may result in prolonged hospitalisation and thus increased costs. Numerous studies have shown that aggressive high-dose regimens of loop diuretics can be safely and effectively used in elderly patients with severe HF. Continuous intravenous infusions are a particularly effective method for delivering high daily doses of diuretics and rapidly removing large amounts of excess sodium and water. In our experience, continuous intravenous infusions are a well tolerated and effective treatment, which may shorten the duration of hospitalisation and in turn reduce the costs of treating elderly patients with HF.