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Different loop diuretic dosing and administration in acute heart failure (DIUR-AHF): a multicenter prospective
Alberto Palazzuoli1, Filippo Pirrotta1, Andrea Stefanini2
1Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department le Scotte Hospital University of Siena Italy.
European Journal of Internal Medicine
|June 3, 2025
Summary
Continuous intravenous infusion (CiV) of loop diuretics in acute heart failure (AHF) improves NT-proBNP reduction and weight loss but is linked to poorer outcomes. High-dose (HD) furosemide also increases risks in AHF patients.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Loop diuretics (LD) are crucial for acute heart failure (AHF) treatment.
- Optimal LD administration modality in AHF remains a concern.
- This study investigates different LD regimens and dosages in AHF.
Purpose of the Study:
- To compare the effects of continuous intravenous infusion (CiV) versus twice-daily bolus intravenous injections (BiV) of furosemide in AHF patients.
- To evaluate the impact of high-dose (HD) furosemide administration on AHF outcomes.
- To assess primary endpoints including rehospitalization or cardiovascular death within 6 months.
Main Methods:
- Multicenter prospective observational open-label study involving 402 AHF patients.
- Patients received either CiV or BiV furosemide for 72-120 hours.
- High dose (HD) defined as >120 mg/day; eligibility required NT-proBNP >500 pg/ml and signs of congestion.
Main Results:
- CiV showed higher NT-proBNP decrease (63% vs 45%) and weight loss (-4.3 vs -3.2 Kg) compared to BiV.
- BiV resulted in shorter hospital stays (11.5 vs 12.7 days) and fewer adverse events (29% vs 45%).
- HD administration was linked to prolonged hospital stays and poorer outcomes (55% vs 18%).
Conclusions:
- CiV furosemide in AHF improves natriuretic peptide reduction and weight loss but is associated with worse clinical outcomes.
- High-dose furosemide in AHF increases the risk of adverse events and rehospitalization.
- Bolus intravenous injection (BiV) may offer a safer alternative for LD administration in AHF.
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