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Clinical implication of initial intravenous diuretic dose for acute decompensated heart failure

Kenji Yoshioka1,2, Daichi Maeda3,4, Takahiro Okumura5

  • 1Department of Cardiology, Kameda Medical Center, Chiba, Japan.

Scientific Reports
|February 9, 2022
PubMed

Insights

For acute heart failure (AHF), using guideline-recommended initial intravenous diuretic doses is feasible. Lower doses increased hospital stay, while higher doses correlated with increased 60-day mortality.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Research

Background:

  • Intravenous diuretics are crucial for acute heart failure (AHF) management.
  • Optimal initial dosing strategies for intravenous diuretics in AHF remain uncertain.
  • Guideline-recommended doses are individualized based on prior oral diuretic use.

Purpose of the Study:

  • To evaluate the impact of initial intravenous diuretic dosing relative to guidelines on AHF patient outcomes.
  • To compare 60-day mortality, diuretic response, and hospital length of stay based on initial dose categories.

Main Methods:

  • Post-hoc analysis of the prospective, multicenter REALITY-AHF registry.
  • Patients categorized into 'Below', 'Standard', or 'Above' guideline-recommended initial intravenous diuretic doses.
  • Outcomes analyzed included 60-day mortality, 6-hour diuretic response, and length of hospital stay.

Main Results:

  • Patients receiving lower-than-recommended doses had significantly longer hospital stays and poorer diuretic response compared to the standard dose group.
  • Patients receiving higher-than-recommended doses showed a significantly higher incidence of 60-day mortality.
  • These associations persisted after adjusting for relevant prognostic factors.

Conclusions:

  • Adherence to guideline-recommended initial intravenous diuretic doses is associated with favorable outcomes in AHF.
  • Dosing below recommendations may prolong hospitalization, while exceeding recommendations increases mortality risk.
  • The findings support the feasibility and clinical relevance of guideline-based initial diuretic dosing in AHF management.

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