An Analysis of Initial Loop Diuretic Dosing Strategies and Its Association with Time to Decongestion

Background: There is currently a lack of evidence on the optimal loop diuretic dosing strategy in cases of acute decompensated heart failure (ADHF). Current consensus recommendations suggest starting with a dose of at least 2 times the patient's home loop diuretic dose. Objective: This study assessed whether higher initial loop diuretic doses are associated with faster time to decongestion in hospitalized ADHF patients. Methods: This was a retrospective, single-center cohort of patients ≥19 years of age with ADHF who received intravenous (IV) loop diuretics between September 2022 and August 2023. Patients were separated into groups based on receipt of greater than or equal to 2.5 times their home loop diuretic dose (high-dose) and <2.5 times their home loop diuretic dose (low-dose). Results: In total, 114 patients were included with 74 patients in the high-dose group and 40 patients in the low-dose group. For the primary outcome of time to decongestion, there was no difference between the high-dose and the low-dose -0.37 (95% confidence interval [CI] = -1.32 to 0.58), P = 0.44. There was a difference in the need for diuretic intensification beyond 24 hours in favor of the high-dose group (P = 0.0001). Conclusion: Higher initial doses of loop diuretics did not lead to a more rapid time to decongestion. The high-dose group did require less diuretic intensification beyond 24 hours, but this was not associated with a shorter hospital length of stay (LOS).