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Diuretic dosing in acute decompensated heart failure: lessons from DOSE
Patrick T Campbell1, Jason Ryan
1Department of Cardiovascular Medicine, Ochsner Medical Center, 1516 Jefferson Highway, Jefferson, LA 70121, USA.
Current Heart Failure Reports
|June 16, 2012
Summary
For acute decompensated heart failure, intravenous furosemide bolus dosing is as effective as continuous infusion. High-dose diuretics improve outcomes without significant renal risk.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Intravenous (IV) diuretics are the standard treatment for acute decompensated heart failure (ADHF).
- Limited randomized trials exist to guide optimal IV diuretic administration strategies.
Purpose of the Study:
- To compare the efficacy and safety of bolus versus continuous infusion IV furosemide in ADHF patients.
- To evaluate the effectiveness and renal safety of high-dose versus low-dose IV furosemide therapy.
Main Methods:
- The Diuretic Optimization Strategies Evaluation (DOSE) trial employed a prospective, randomized design.
- Patients received either bolus or continuous infusion IV furosemide.
- Dosing was stratified into high-dose versus low-dose regimens.
Main Results:
- No significant difference was observed in the primary endpoint between bolus and continuous infusion strategies.
- High-dose furosemide demonstrated greater efficacy compared to low-dose therapy.
- Clinically significant renal function decline was not more frequent with high-dose diuretics.
Conclusions:
- Continuous infusion of IV furosemide is not superior to bolus administration for ADHF treatment.
- High-dose diuretic therapy is effective and safe regarding renal function in ADHF patients.
- Findings challenge established clinical beliefs regarding diuretic administration and renal toxicity.
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